Reimbursement policy guidance for diagnosis coding on inpatient claims
This document outlines UnitedHealthcare's reimbursement policy expectations for accurate diagnosis coding (ICD-10-CM) when submitting inpatient claims and explains that published reimbursement policies use coding systems for definitional purposes; applicability is to providers submitting inpatient claims under UnitedHealthcare Medicare Advantage reimbursement policies.
No material clinical or coverage changes in this revision.
Diagnosis Coding
| ICD-10-CM | Diagnosis coding system required for submission of claims |
Provider Coding Expectations
Submit accurate ICD-10-CM diagnosis codes
Providers must accurately submit diagnosis codes that comply with ICD-10-CM requirements; reimbursement decisions are based on the code(s) that correctly describe services provided.
- Submit inpatient claims using ICD-10-CM diagnosis codes that accurately reflect the patient’s condition.
- Ensure coding aligns with applicable coding guidelines because reimbursement is determined by the codes submitted.
Reimbursement Policy Definitions
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