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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