A growing share of hospital patients are being coded as medically complex, and the Blue Cross Blue Shield Association says artificial intelligence tools are a major reason. In an analysis released Sept. 24, the insurer group reported that complex cases rose from 37% of inpatient claims for its member plans at the start of 2023 to 40% by the end of 2025, with no matching change in the care patients received.
The dispute is usually framed as a money fight between hospitals and insurers. But diagnosis codes do not appear only on bills. They become part of the records that follow patients, which raises a question most people rarely ask: Does my hospital record accurately describe how sick I was?
