Dos and Don'ts to Submit ICD-10-CM/PCS and HCPCS Questions
The AHA Central Office serves as the official coding clearinghouse on the proper use of the ICD-10-CM, ICD-10-PCS and HCPCS Level II classification systems. Our office provides coding advice regarding the proper application of these systems using the Alphabetic Index, Tabular List, Official Coding Guidelines, and AHA Coding Clinic advice.
Coding advice is provided based upon specific medical record documentation submitted for each coding request. Please note, our office cannot provide clinical information and any request asking for clinical interpretation will be returned unanswered.
The Central Office receives hundreds of requests for coding advice a month. In order to ensure that you receive a definitive response to your coding request(s), please read and adhere to the following Do’s and Don’ts prior to the submission of your request(s):
- Do not submit questions without supporting medical record documentation, see FAQ section for more information. Requests submitted without medical record documentation may be returned unanswered.
- 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 FAQ section for more information.
- Do not submit ICD-9-CM questions, nor questions to validate Coding Clinic for ICD-9-CM advice for ICD-10-CM or ICD-10-PCS
- 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. If the reason for admission is not clearly documented in the medical record, the provider should be queried for clarification.
- 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. This includes requests asking what clinical components are inherent to a diagnosis and/or procedure. These clinical matters may be best addressed by querying the provider.
- 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. It is not within our scope of services to code entire medical records. With the number of requests that are received by our office, we simply do not have dedicated resources to undertake such a task. These types of requests may be returned unanswered.
- Do not submit questions asking the Central Office to determine the objective/root operation of the procedure. If the medical record documentation does not clearly indicate the objective of the procedure, query the provider for clarification as that is a clinical issue.
- Do not submit questions or recommendations related to ICD-10-CM Index or Tabular List problems or conflicting instructions. For proposal submission, please send to the following email address: nchsicd10CM@cdc.gov. For more details, 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 proposal submission, please use the Medicare Electronic Application Request Information System (MEARISTM), found at https://mearis.cms.gov/public/home. For more details, 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-DRGs 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, please use the Medicare Electronic Application Request Information System (MEARISTM), found at https://mearis.cms.gov/public/home.
- 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 before submitting your question.
- Do keep track of the question you submitted and the tracking number for your own records.
- Do include HIPAA compliant supporting documentation with your request, see FAQ section for more information.
- Do refer first to the Alphabetical Index, Tabular List, Official Coding Guidelines and Coding Clinic 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 (CPT) 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. Requests submitted without a specific formulated coding question may be returned for clarification and may delay receiving a response to your request.
- 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.