Coding Decisions

7.2.3 - Coding Decisions (Rev. 444, Issued: 12-14-12, Effective: 04- 01- 13 (FISS and MCS); 07-01-13 (VMS); Implementation: April 1, 2013 (Implementation of FISS and MCS); July 1, 2013 (Implementation of VMS) Where used in this Chapter, the term “coding decisions" generally refers to MR decisions. For example, coding decisions include each of the following: • Contractor reviews product information for a durable medical equipment prosthetics, orthotics, and supplies (DMEPOS) item, finds that the wrong code has been billed based upon the review of diagnoses codes and narrative information included on the claim/bill, changes the code to the correct code, and completes the claim. In the situation described above, the Contractor denies the claim line with the wrong code and uses the message that the supplier has incorrectly coded the item. • The Contractor determines that a service billed as a bilateral x-ray is a single view x-ray and indicates a down code to a single view x-ray in the remittance advice. Include only coding decisions that require the application of clinical judgment as part of a review, in writing policies, or in the development of guidelines and processing instructions.