ICD 10 Coding Alert

Note CMS Guidelines for Queries

Williams says your query forms should:

• Be clearly and concisely written
• Present the facts and identify why the clarification is needed
• Present the scenario

Query forms should not:

• Be designed so that the only thing needed is a physician’s signature
• Indicate any financial impact

Rumors abound that some physicians are asking coders to mention reimbursement dollar amounts in their queries. Make sure you steer away from that practice and follow CMS guidelines to remain compliant. Never mention dollar amounts in your queries, Williams stresses.

Queries Should Be in Writing, With These Elements

Written queries are best, but they can be verbal as long as you document the verbal exchange. Queries can even be conducted over email — as long as your practice’s email system is secure and HIPAA-compliant.

The form should list the patient’s name, date of service, medical record number, provider’s name, name and contact of the individual sending the query, date of query, and the statement of the issue in the form of a question or request for additional information.

Word your query carefully so that you “don’t box the provider in,” Williams says. Steer clear of ‘leading’ queries that give providers only one way to answer the question. Williams provided the following example of a leading query:

Was the patient given IV fluids because she was dehydrated? Instead ask, Why was the patient given IV fluids?

Queries should be ‘non-leading,’ even if you think you know what the provider meant to document. You might ask for an addendum or provide multiple-choice options that include an “other” option to help the provider articulate their thinking in the medical note. Pay close attention to the headings you use for queries, Williams cautions, because sometimes headings can cause the query to be leading.

Tip: “Avoid the words ‘you’ and ‘but’ in your queries,” Williams advised. Such language can sometimes provoke a defensive reaction. Instead consider: “Please provide the patient’s condition necessitating the infusion of the 1000ml of normal saline administered.”

Look to Education, Workflow

Because queries take up staff and provider time, they can cost a practice money if queries cover the same topics over and over again. Plus, they can feel like a headache.

However, most providers dislike queries, too, so the revenue department and the coding team should communicate that the ultimate goal of your query program is to reduce the need for queries in the first place. One tactic is to tie documentation to how it impacts the patient—as in what happens to the patient if there is good documentation versus bad, Williams says. “That usually helps the provider understand.”

Williams recommends practices set up a query tracking form in Excel that records:

• Most common reasons for queries
• Providers with a high query percentage
• Providers with a low query rate
• Query themes that reoccur repeatedly: Where might you focus your physician education efforts?
• Provider response turn-around time
• Provider agreement rate: “Be wary of the provider who agrees with the coder’s query 100 percent of the time,” Williams cautions.

Query tracking can help identify patterns and help improve documentation habits. As you build your CDI program, you might enlist the physician who is queried least often to be your CDI champion. If you and the doctors work together, you’ll see a return on investment resulting in better documentation, less back-and-forth time wasted, faster claims submissions, reduced denials and fewer appeals.