Is ChatGPT a viable option for medical coding?

Summary:  No. ChatGPT is great for research and content writing, but it does not have the AMA licensing or CMS software updates to supply you with valid and real-time coding information. In the intricate realm of medical billing and coding, accuracy and up-to-date data are crucial pillars. Although ChatGPT, a sophisticated AI language model developed by OpenAI, boasts a wide-ranging database of general knowledge and support across various fields, it lags behind specialized software such as iVECoder, especially in medical billing and claims. Various factors underline why iVECoder, with AMA licensing and consistent updates aligned with CMS and AMA protocols, outshines in this particular function.

What is ChatGPT really?

ChatGPT is a powerful AI-driven conversational assistant based on large language models (LLMs). It operates through machine learning—trained on vast amounts of publicly available internet text, and generates responses by predicting patterns and language associations. ChatGPT is not licensed by the AMA or CMS, does not provide real-time coding updates or compliance safeguards, and primarily functions as a generalist tool rather than a dedicated healthcare engine.

Free vs Paid Versions of ChatGPT

Free version – This level grants users access to GPT-3.5, a capable language model for basic content generation, casual inquiries, and general-purpose Q&A. However, it lacks integration with plugins, coding tools, or advanced research features. It also operates on a static knowledge base that does not include current-year regulatory changes, medical billing codes, or CMS/AMA updates.

Paid ChatGPT Plus (agent mode) – Subscribers gain access to GPT-4, a more advanced model capable of more prolonged, more context-aware interactions. It can use built-in tools such as a code interpreter or a browser (in some configurations), and it supports limited plugin integration. However, while more responsive and powerful, it still does not offer verified clinical data, AMA licensing, or real-time coding validation—making it unsuitable for compliance-based healthcare tasks.

Paid enterprise with deep research – This model is used by organizations that purchase custom deployments of GPT-4 and may integrate it with private datasets or internal tools. Some health systems experiment with this tier to analyze documentation patterns or augment administrative workflows. However, even in these enterprise use cases, ChatGPT is not AMA-licensed and cannot act as a standalone medical coding tool. It requires extensive safeguards, audits, and human review to remain compliant.

Why ChatGPT falls short with medical coding

Coding standards are not static. CPT®, ICD-10, and HCPCS Level II codes are revised annually, and CMS regulations are updated quarterly. ChatGPT’s training cutoffs prevent it from incorporating these updates in real time—meaning its code guidance may be outdated or invalid the moment a new rule takes effect. Mistakes in billing codes can lead to claim rejections or denials, compliance flags, revenue leakage, and triggered payer audits. Relying on a general-purpose tool for a specialized, highly regulated task introduces unacceptable risk.

Is there an AI AMA-compliant software?

Yes, iVECoder® is a purpose-built coding software designed to meet the strict requirements of CMS and AMA.

iVECoder uses curated, AMA-licensed datasets with CMS NCCI and policy edits layered into its rules engine. Unlike open-ended AI models, it doesn’t guess. It confirms. It provides structured coding workflows, flags incompatibilities and modifier issues in real time, and includes pre-billing audits and code validation checkpoints.

By continuously incorporating AMA and CMS updates, iVECoder reduces the risk of upcoding or undercoding, code mismatches, modifier misuse, and violations of outdated policies. Its design prevents risky billing behavior before claims are ever submitted.

iVECoder is fully compliant with HIPAA standards and, unlike generative AI models, does not process unstructured patient data via external networks. It stores audit trails for every coding decision, operates within a protected, non-Internet-facing environment, and avoids sending sensitive data to third-party APIs or training pipelines.

Final Thoughts on ChatGPT, AI, Medical Coding

If your organization is committed to clean claims, coding compliance, and minimizing audit risk, ChatGPT is not a viable option for your coding operations. It is fantastic for remedial research and non-PHI/HIPAA-related tasks, but for medical coding, iVECoder is the only option for billers, clinics, hospitals, and RCM companies.