List Procedure by RVU, Not Cost
Question: When I’m reporting multiple procedures on a claim, which should I list first? And how should I differentiate? Alabama Subscriber Answer: When you’re billing for procedures, you should report the services according to their relative value units (RVUs), said Corella Lumpkins, CPC, CPCO, CDEO, CPB, CPMA, CPPM, CRC, CVBA, CPC-I, CEMC, in her 2025 HEALTHCON Regional Presentation “Maximize Revenue: Post-Payment Compliance Practices.” Payers sometimes follow a path when paying a claim, where they pay most of the first procedure listed and then smaller percentages of the other procedures listed, Lumpkins said. If you put the highest-value procedure on line 3, you may be leaving money on the table, she said. Payers won’t look at the claim and say, “Oh, they put the higher code on line 3, so we should really move that up to line 1 and pay 100 percent of that, instead of the 25 percent we’d pay for it being on line 3” Lumpkins warned. She also wanted billers and coders to make sure to look at the RVUs and not just price, because prices may be adjusted according to payer. Billing according to RVUs enables more consistent payment for claims, maximizing reimbursement because payers aren’t going to rework your claim order for you. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
