Coding Corner

Here you’ll find information and resources, developed in partnership with the Optum® Payment Integrity team of certified coders and nurses, to help decrease the potential for claim denials.

We use facility and professional claims history to identify opportunities to improve coding accuracy through proactive education. 

Featured Course: Facility Coding for Sepsis

Learn about the DRG Coding Guidelines and UnitedHealthcare Clinical Review Guidelines used during clinical validation audits of claims with sepsis-related diagnosis.  

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Acute Respiratory Failure Clinical Criteria

Acute Respiratory Failure Coding Considerations

Encephalopathy Clinical Criteria

Encephalopathy Coding Considerations

Facility Billing and Review Process

Malnutrition and Marasmus Clinical Criteria

Malnutrition and Marasmus Coding Considerations

Pneumonia Clinical Criteria

Pneumonia Coding Considerations

Sepsis-2 Clinical Criteria

Sepsis-3 Clinical Criteria

Sepsis Clinical Criteria - State of New York Only

Sepsis Coding Considerations

Anesthesia and Integral Services Unbundling

Anesthesia Upcoding and Pricing Modifiers

Moderate Conscious Sedation

Complex Repair Upcoding

Laser Psoriasis Treatment Upcoding

Mohs Surgery Coding

Mohs Surgery Unbundling

Other Repair Coding and Unbundling

Photochemotherapy Upcoding

Advance Care Planning Upcoding and Unbundling

Critical Care Upcoding

Hospital Inpatient E/M Upcoding 

Hospital Observation E/M Upcoding 

Nursing Facility E/M Unbundling 

Nursing Facility E/M Upcoding

Pediatric and Neonatal Critical and Intensive Care Unbundling

General Lab Billing Guidance 

Genomic Panel, Molecular Pathology and PLA Code Unbundling

Organ or Disease-Oriented Lab Panel Unbundling

Presumptive and Definitive Drug Test Unbundling

2021 Evaluation and Management (E/M) Changes

Allergen Injection and E/M Unbundling

Cardiovascular and E/M Service Unbundling

Chemotherapy Administration and E/M Unbundling

Injection or Infusion and E/M Unbundling

Multiple E/M Service Unbundling 

Office E/M Upcoding 

Preventive Services and E/M Unbundling 

Always Therapy Service Required Modifiers 

Occupational Therapy Evaluation Upcoding

Physical Therapy Evaluation Upcoding

Speech Language Pathology Service Unbundling

Time-Based Therapy Procedure Upcoding 

Cerumen Removal and E/M Unbundling

Exceeding Medically Unlikely Edit Values

Global Surgery Package Unbundling 

Procedure-to-Procedure Code Pair Unbundling

Transthoracic Echocardiogram Upcoding

Diagnostic Radiology and E/M unbundling

IMRT Unbundling and Exceeding MUE/MFD Values 

Myocardial Perfusion Imaging (MPI) Unbundling

Radiology and E/M Unbundling

CPT Category II Codes