Compare Claude Sonnet, GPT-5 for clinical notes to ICD-10/CPT codes. From $120/mo for 10K notes. Accuracy vs audit risk benchmarked.
Your usage
Default assumptions
Monthly requests10,000
Avg input tokens4000
Avg output tokens800
When to use this scenario
Medical coding translates clinical notes, discharge summaries, and operative reports into standardized ICD-10 diagnosis codes and CPT procedure codes for insurance billing. Coding errors directly affect reimbursement: undercoding loses revenue, overcoding triggers audits and CMS clawbacks. The financial stakes make accuracy the dominant metric — not cost.
Claude Sonnet handles multi-condition notes better than smaller models, correctly mapping comorbidities to their appropriate secondary codes and flagging when documentation is insufficient to support a specific code. At 10K notes/month with 4K average input, the monthly bill is $120 in input tokens — compared to $50,000+/month for a human coding team of equivalent throughput.
Production deployments require a human coder to review AI suggestions before claim submission. The model's role is to pre-populate the code set and flag documentation gaps, not to submit codes autonomously.
Common pitfalls
Accepting the first suggested code without validating specificity — ICD-10 often has more specific codes at the 5th or 6th digit that affect reimbursement differently
Processing truncated notes — if a discharge summary references "see progress notes from Day 3," omitting those notes produces incomplete coding
Using a general-purpose model without medical coding prompts that include official guidelines (CMS, AHA Coding Clinic) as few-shot examples
Not tracking payer-specific bundling rules: a CPT code covered by Medicare may not be separately billable under a commercial payer's fee schedule
Drag the slider to split traffic between Claude 4.6 Sonnet (primary) and GPT-5 mini (fallback). See how your monthly bill moves — without writing a line of gateway code.
Primary: Claude 4.6 SonnetFallback: GPT-5 mini
70% Claude30% GPT-5
Blended monthly cost$176at the usage assumed above
Vs all-primary−27%$240 → $176
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PHASE 2 PREVIEW · gateway not live yetThis endpoint does not exist yet. The gateway is in Phase 2 — what you see below is a design preview of the planned interface, not a live API. We will email subscribers when it launches.
