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#SMT EP #182 | UHC Excludes1 Rules: What Coders Must Know Now Hi friends! Pour yourself a cup of tea and settle in, because we need to talk about a policy change that's about to impact every medical coder working with UHC Medicare Advantage claims. Starting February 1, 2026, UnitedHealthcare is enforcing ICD-10-CM Excludes1 rules—and by March, this applies to ALL claim types. On the surface, this sounds straightforward. But here's what they're not telling you: the ICD-10-CM Guidelines have a critical exception that allows both Excludes1 codes to be reported when conditions are unrelated. Dr. James Kennedy's analysis exposes the gaps in UHC's policy and shows us exactly where inappropriate denials will happen. As coders, we need to understand not just the rule, but the exception—and how to defend our work. In this episode of Saturday Morning Tea, we're breaking down: ✅ What Excludes1 rules actually mean (and what UHC is missing) ✅ Real examples where both codes are correct ✅ How to protect your organization from inappropriate denials ✅ Three strategic pivots every coder needs to make right now ✅ Actionable steps to implement this week This isn't just about coding—it's about protecting revenue, supporting quality metrics, and positioning yourself as the expert your organization can't live without. As healthcare becomes more automated, your ability to understand these nuances is what keeps you invaluable. Grab your coding manuals and let's make sure you're ready. Because at the end of the day, it could all be so simple when we understand the guidelines and advocate for accurate coding. Resources mentioned: FY 2026 ICD-10-CM Official Guidelines UHC Medicare Advantage Reimbursement Policy Update Bulletin (January 2026) AHA Coding Clinic for ICD-10-CM (specific quarters referenced in video) #MedicalCoding #ICD10CM #UnitedHealthcare #HealthcareCompliance #ReimbursementPolicy #CodingEducation 📌📌 SUPPORT THE CHANNEL 💥 Join the PRN Tea Sippers to get access to perks such the Meeting After The Meeting, community-only posts, members-only connections and entrepreneur ☕️. Want to get that extra hot exclusive tea? To learn more click the link ☕️https://bit.ly/theprnteasippers ✅ For our free course on the 5 steps on how to become a certified marketable medical coder click here: http://bit.ly/5stepscoder. 🔗 Connect with me: ▶️ Visit our website at http://www.ohioprn.com ▶️ Like us on Facebook:   / prncodingedu   ▶️ Follow us on Instagram:   / prncodingedu   💎 Follow for more coding education and revenue cycle insights