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Dos and Don'ts
- Do not submit questions without supporting documentation, see Help Center section for more information.
- Do not submit any document that contains Personal Health Information (PHI), physician name or hospital name.
- Do not submit ICD-10-PCS coding questions related to outpatient procedures, see Help Center section for more information.
- Do not submit ICD-9-CM questions.
- Do not submit questions related to payment or coverage issues.
- Do not submit questions related to interpretation of medical record documentation, such as identifying the principal diagnosis—unless it relates to the application of specific coding guidelines or specific previously published coding advice.
- Do not submit questions related to completion of OASIS (the Outcome and Assessment Information Set) or IRF-PAI (Inpatient Rehabilitation Facility Patient Assessment Instrument) forms.
- Do not submit questions related to missing or incomplete documentation or validation of what is appropriate documentation (paper or electronic).
- Do not submit questions related to clinical issues or clinical criteria for diagnoses or procedures.
- Do not submit questions related to mediating differences of opinion between providers and auditors or payers or any other third party reviewers—unless it relates to the application of specific coding guidelines or specific previously published coding advice.
- Do not submit requests for the Central Office to code the entire medical record or operative report or to validate code assignment.
- Do not submit questions or recommendations related to ICD-10-CM Index or Tabular List problems or conflicting instructions. For information on submission of ICD-10-CM code changes visit https://www.cdc.gov/nchs/icd/icd10_maintenance.htm#Submission
- Do not submit questions or recommendations regarding ICD-10-PCS Index entries, ICD-10-PCS device definitions, ICD-10-PCS Reference manual or the General Equivalence Mappings (GEMS) . For information on submission of ICD-10-PCS code changes visit https://www.cms.gov/Medicare/Coding/ICD10/newrevisedcodes
- Do not submit HCPCS questions/inquiries from physician providers related to CPT-4., Do not submit HCPCS level II questions/inquiries related to durable medical equipment, prosthetics, orthotics, and other supplies.
- Do not submit issues related to MS-DRG's and reimbursement. The MS-DRG Grouper is the responsibility of the Centers for Medicare & Medicaid Services (CMS). To recommend MS-DRG changes, complications/comorbidities (CC) or major complications/comorbidities (MCC) and other MS-DRG related issues you may contact them at MSDRGClassificationChange@cms.hhs.gov.
- Do not submit duplicate questions, this will delay processing.
- Do not use this feature for general correspondence or questions, email us at firstname.lastname@example.org.
- Read the Frequently Asked Questions (Help Center) before submitting your question.
- Do include HIPAA compliant supporting documentation with your request, see Help Center section for more information.
- Do refer first to the Alphabetical Index, Tabular List, Official Coding Guidelines to determine if there is previous guidance to help answer your question.
- Do submit questions that relate to the application of specific coding guidelines.
- Do submit questions regarding specific advice previously published in Coding Clinic.
- Do submit HCPCS level 1 questions for hospital providers.
- Do submit certain subset of HCPCS level II: such as A-codes, for ambulance services and radiopharmaceuticals, C-codes, G-codes, J-codes and Q-codes other than Q0136 through Q0181.
- Do be as specific as possible and explain what the coding problem is.
- Do be sure to specify the type of care setting (e.g. inpatient, outpatient, long term acute care hospital, home care), as the answer may vary depending on applicable rules or type of encounter.