Hospitals’ increasing use of artificial intelligence for patient coding has increased the frequency of inpatient stays classified as medically complex—boosting the bills sent to payers despite no apparent changes in the care being delivered, according to a new claims analysis from the Blue Cross Blue Shield Association.

The association found that the share of medically complex cases billed to its Blue plan members has risen from 37% at the beginning of 2023 to 40% by the end of 2025.

About 70% of the coding intensity increase stems from more than 55,000 more cases from the 2023 baseline in which secondary diagnoses pushed a claim into a higher-severity, higher-reimbursement diagnosis-related group (DRG).

The increase in coding intensity since baseline translates to an estimated $942 million of additional costs shouldered by BCBSA’s member plans over two years, of which $653 million stemmed from secondary diagnoses ($11,000 per excess complex case).

“Critically, what we found is underneath all of that data [was] no change in corresponding care for a more complex patient,” Luke Chalker, senior vice president of product and data science at BCBSA and one of the analyses’ authors, told reporters during a briefing on the findings. “We now see that coding has materially changed. We see that. Non-Blues see that—they talk about it sometimes in earnings reports and things like that. But we find no evidence of a corresponding change in care, and that’s because the reimbursement mechanisms that exist allow this.”

Chalker and other BCBSA leads who spoke to reporters described the increases—particularly those with no accompanying changes in care delivery—as unnecessary healthcare spending for plans that then leads to higher premiums and out-of-pocket costs for enrollees, employers and taxpayers.

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