Pediatric Coding Alert

Question: I've heard that I'm going to have to start changing some of the codes that I bill to UnitedHealthcare (UHC) because it's changing its policies. Is that true?

New Jersey Subscriber

Answer: To some degree that may be true. Last summer, UHC announced it would be implementing a new reimbursement policy. The carrier planned to begin following all CMS Correct Coding Initiative (CCI) edits in November 2007.

"These edits, which follow correct coding guidelines established by CMS, will supplement edits currently administered under UHC's reimbursement policies, including the Rebundling Policy," UHC told its providers.

New date: UHC had to bump its original implementation date, and the new edits were rescheduled to take effect in December. According to UHC, until the carrier's system updates with the new edits, your reimbursement will continue to follow past reimbursement policies because the insurer posts them online. The new policy, once in effect, will apply to any services you report using the CMS-1500 form and its electronic equivalent.

Look to future Pediatric Coding Alert issues to prep you on the edits you'll need to be aware of when CCI becomes effective for UHC.