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.
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