Claim coding and inquiry process guidelines

Humana guidelines and best practices

For detailed information about Humana’s claim payment inquiry process, review the claim payment inquiry process guide (300 KB). , PDF opens new window

The following links are intended to facilitate documentation and coding diagnoses and services that are provided to patients with Humana coverage:*

Atrial fibrillation coding guidelines , PDF opens new window

Cardiomyopathy coding guidelines , PDF opens new window

Cerebrovascular accident (CVA) coding guidelines , PDF opens new window

Chronic kidney disease (CKD) coding guidelines , PDF opens new window

Chronic obstructive pulmonary disease (COPD) coding guidelines , PDF opens new window

Deep vein thrombosis (DVT) coding guidelines , PDF opens new window

Diabetes mellitus coding guidelines , PDF opens new window

Heart failure coding guidelines , PDF opens new window

Major depression/major depressive disorder coding guidelines , PDF opens new window

Myocardial infarction coding guidelines , PDF opens new window

Neoplasms coding guidelines , PDF opens new window

Neoplasms (breast cancer addendum) coding guidelines , PDF opens new window

Neoplasms (prostate cancer addendum) coding guidelines , PDF opens new window

Obesity/body mass index (adult) coding guidelines , PDF opens new window

Peripheral vascular disease (PVD) coding guidelines , PDF opens new window

Pressure injury coding guidelines , PDF opens new window

Rheumatoid arthritis (adult) coding guidelines , PDF opens new window

Seizures/seizure disorder/epilepsy coding guidelines , PDF opens new window

Sick sinus syndrome (SSS) coding guidelines , PDF opens new window

Vertebral fractures coding guidelines , PDF opens new window

*The external coding guidelines provided on this website are intended as general information only and are designed to communicate information about coding and documentation in an educational format. Humana is not providing or offering medical or legal advice, but rather, practical and useful information and tools in the area of clinical documentation and coding. Every reasonable effort has been taken to ensure that the educational information provided is accurate and useful. We make no claim, promise or guarantee of any kind about the accuracy, completeness or adequacy of the content for a specific claim, situation or provider office application and expressly disclaim liability for errors and omissions in such content. No guarantee is provided that the use of this information will prevent differences of opinion or disputes with Medicare, Medicaid or other third-party payers as to the amount that will be paid to providers. As diagnostic codes change annually, you should reference the current version of published coding guidelines and/or recommendations from nationally recognized coding organizations for the most detailed and up-to-date information. No copy or use beyond the online access or internal use of this presentation by an individual provider office should occur without express permission of Humana.

Diagnosis coding documentation

Industry-standard diagnosis coding guidelines require a strict literal interpretation to the health care provider’s medical record documentation