Medical Coding Global Market Report 2024

The medical coding market size has grown strongly in recent years. It will grow from $16.72 billion in 2023 to $18.19 billion in 2024 at a compound annual growth rate (CAGR) of 8.8%. The growth during the historical period can be attributed to the expansion of the healthcare industry, the implementation of ICD and CPT coding systems, the transition towards electronic health records (EHRs), compliance with regulatory requirements, and the trend toward specialization and subspecialization within healthcare.

The medical coding market size is expected to see strong growth in the next few years. It will grow to $26.04 billion in 2028 at a compound annual growth rate (CAGR) of 9.4%. The anticipated growth in the forecast period is linked to several factors: the investment in workforce training and development, the expansion of the global healthcare market, evolving regulatory changes and compliance requirements, the growth of telehealth and remote medicine, and the shift towards value-based care models. Major trends expected during this period encompass the development of education and training programs, the prevalence of remote work and outsourcing in healthcare, the integration and interoperability of Electronic Health Records (EHR), the rising demand for specialty-specific coding, and an increased emphasis on accuracy and quality standards within the industry.

The increasing necessity for a standardized language in medical documentation is expected to drive the growth of the medical coding market. The healthcare industry generates vast amounts of data that can be challenging to organize manually without standardized labels or names, making it difficult to reference patient histories efficiently. Converting medical records into universal alphanumeric codes facilitates streamlined hospital billing processes, ensuring accurate billing reimbursement and enabling effective tracking of patients' health records for future reference. This growing demand for medical codes that aid in organizing medical data and streamlining processes is expected to reduce inefficiencies associated with manual data recording without universal codes. For example, the International Classification of Diseases (ICD) maintained by the World Health Organization is used globally for reporting and coding data related to human diseases and mortality. Moreover, in October 2022, the American Medical Association (AMA) released the Calendar Year (CY) 2023 Current Procedural Terminology (CPT) code set, which included 102 new codes, 68 removed codes, and modifications to 87 codes. This continuous use and development of universally accepted codes are driving the growth of the medical coding market. In summary, the need for standardized language in medical documentation and the utilization of universally accepted codes are key factors contributing to the expansion of the medical coding market.

The increasing incidence of insurance fraud is expected to drive the growth of the medical coding market in the coming years. Insurance fraud involves intentionally providing misleading or inaccurate information to an insurance company to obtain unlawful benefits or payments. Medical coding plays a crucial role in identifying insurance fraud by ensuring accurate and standardized documentation of healthcare services, which makes it easier to detect discrepancies and irregularities in insurance claims. For example, according to the Association of British Insurers in August 2023, the average insurance fraud case increased by 20% to £15,000 in 2022. Therefore, the rising incidence of insurance fraud is a key factor driving the growth of the medical coding market.

The medical coding market is witnessing increased adoption of artificial intelligence (AI) as a prominent new trend. AI refers to the simulation of human intelligence in machines programmed to think and mimic human actions. This adoption of AI is expected to streamline medical billing workflows, improve the accuracy of medical coding, and enhance overall efficiency. This trend is particularly relevant given the growing volume and complexity of healthcare data. Furthermore, AI in medical coding is anticipated to reduce the need for extensive searches to find appropriate codes for unstructured data, thereby alleviating medical coding fatigue. For example, in November 2022, Maverick Medical AI, an Israel-based autonomous medical coding company, launched its autonomous medical coding platform to meet RadNet's medical coding requirements in the US. This platform aims to optimize revenue cycle management processes, reduce operating expenses, and increase reimbursement for RadNet. Maverick Medical AI's platform integrates medical coding expertise with innovative machine learning and dynamic AI. It autonomously analyzes clinical notes and reports, accurately generating reimbursement codes (ICD-10, CPT) in real-time and making charges accessible to billing systems within seconds.

Major companies in the medical coding market are focusing on innovative technologies such as automated medical coding for inpatient care to better serve their existing consumers. Automated medical coding for inpatient care involves using technologies such as artificial intelligence (AI) and machine learning algorithms to analyze and extract essential data from patient records, clinical notes, and other healthcare documentation. For example, in November 2023, Nym Health, a US-based company specializing in autonomous medical coding, introduced professional (Profee) coding for interactions in skilled care facilities, observation units, and inpatient stays. Given the high volume of inpatient interactions in hospitals and health systems, there is a need for efficient profee coding, especially with a limited number of coders available to manage the demand. Nym's inpatient professional services encompass diagnostic coding, evaluation and management (E/M) coding, bedside operations coding, modifiers, and provider attribution, aiming to streamline the coding process and improve accuracy in medical billing and documentation.

In September 2021, AGS Health, a US-based provider of revenue cycle management solutions for healthcare providers, acquired EZDI Inc for an undisclosed sum. This acquisition is anticipated to enhance operational efficiency and improve outcomes by leveraging EZDI's technology, which is designed to predict appropriate medical codes and identify missed documentation. EZDI Inc is a US-based provider of integrated AI-based clinical documentation and medical coding platforms.

Major companies operating in the medical coding market report are 3M Company, Advanced Medical Coding Services, AcerHealth Inc., Aveanna Healthcare LLC, AthenaHealth, AAPC (American Association of Professional Coders), Codemasters Inc., EqualizeRCM Services, Alpha Coding Experts LLC, Accurate Medical Coding LLC, American Medical Billing & Coding Services, Apex Medical Billing & Coding, Associated Medical Billing & Coding, Beacon Healthcare Coding, Billing Advantage LLC, Blue Star Medical Billing & Coding, Brite Medical Coding, Care Medical Coding, Central Billing Services LLC, Certified Medical Billing Specialists, Code 1 LLC, Coding Masters, Complete Medical Coding Solutions, Cypress Medical Coding, Data Plus Services, Dedicated Medical Billing & Coding, Empower Medical Billing & Coding Services, Expert Medical Coding, First Class Medical Billing & Coding, Global Medical Billing & Coding, Greenlight Medical Billing & Coding.

North America was the largest region in the medical coding market in 2023. Asia-Pacific is expected to be the fastest-growing region in the forecast period. The regions covered in the medical coding market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa. The countries covered in the medical coding market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.

The components of medical coding include in-house and outsourced coding services. In-house medical coding refers to the process of coding being handled within the organization using coding software. This approach can result in lower costs and more effective management of coding-related issues. Medical coding relies on classification systems such as the International Classification of Diseases (ICD), the Healthcare Common Procedure Coding System (HCPCS), and Current Procedural Terminology (CPT). These coding solutions are used in diagnostic centers and by hospitals and healthcare providers to accurately record diagnoses and procedures for billing and data analysis purposes.

The medical coding market research report is one of a series of new reports that provides medical coding market statistics, including medical coding industry global market size, regional shares, competitors with a medical coding market share, detailed medical coding market segments, market trends and opportunities, and any further data you may need to thrive in the medical coding industry. This medical coding market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.

The medical coding market includes revenues earned by entities by providing services such as HCC Coding, Offshore coding audit, payer specific coding requirements, and code review services. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.