Question 1

Why would I compare two CPT codes?

Accepted Answer

You compare codes to determine which is more appropriate for a specific procedure. Different codes have different RVUs, denial rates, and documentation requirements. Choosing the right code increases reimbursement and reduces denials.

Question 2

What information does the comparison show?

Accepted Answer

RVU values (work, practice expense, malpractice), Medicare payment amount, historical denial rates, common denial reasons, documentation requirements, use cases, and when to use each code.

Question 3

Can I use this for coding my claims?

Accepted Answer

This tool is educational. Always consult your coding compliance officer or billing specialist before changing how you bill. Some codes may be more specific to your specialty or practice setting.

Question 4

What's a reasonable denial rate?

Accepted Answer

Industry average is 5-10% denial rate. Rates above 15% suggest the code has bundling issues, documentation requirements, or medical necessity concerns. Investigate high-denial codes with your billing team.

Question 5

How often do code values change?

Accepted Answer

CPT codes are updated annually in January. RVU values change each January based on the Medicare Physician Fee Schedule. Commercial insurance changes vary—check with each payer separately.

Question 6

What if both codes have similar RVUs?

Accepted Answer

If RVUs are similar, compare denial rates and documentation requirements. Lower denial rates with simpler documentation may be preferable, even with slightly lower RVUs.

Question 7

Can I compare codes across specialties?

Accepted Answer

Yes, but interpretation depends on specialty. Primary care might use different codes than cardiology for similar work. Compare codes only within your specialty for accurate benchmarking.

Question 8

Where do the denial rates come from?

Accepted Answer

Denial rates are derived from Medicare claims data and medical billing research. Your actual denial rates may vary based on payer, documentation quality, and specialty. Use these as reference points.

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