Oncology & Hematology Coding Alert

Read on for answers to your most frequently asked questions.

Physician queries-and the answers to them-are a crucial part of any clinical documentation improvement (CDI) program. But writing queries and analyzing query data as you grow your oncology practice's CDI program requires smarts and skills.

In a class she taught at the American Academy of Professional Coders Regional Conference in Salt Lake City, Leonta Williams, RHIT, CPCO, CPC, CEMC, CHONC, CCS, CCDS schooled attendees on the art and science of writing queries. If your RCM department knows how to write good queries, you can help clinicians improve their clinical documentation and improve your ICD-10-CM coding, noted Williams, who is director of medical coding at Georgia Cancer Specialists. Without further ado, here are the FAQs.

What is a query?

Answer: You write a query when something about the physician's documentation is confusing you. Before you submit a query, make sure you've brushed up enough on your clinical skills to understand what you're reading, Williams stressed. If you submit a query about clinical information you should know, "that lessens your credibility" in your practice.

Send a query when you're confused because the documentation seems to be missing a key fact. For example, the note may contain signs and symptoms, but not a documented condition. (And, you're pretty sure the provider isn't waiting on lab or biopsy results.) Or, the note may contain what appears to be conflicting information. Or, perhaps you need additional information in order to assign the correct ICD-10-CM code. You might even be dealing with a paper record that contains illegible handwriting.

"A query is a routine communication and education tool used to advocate complete and compliant documentation," according to the American Health Information Management Association. "The desired outcome is an update of the health record to better reflect the provider's intent and clinical thought process," AHIMA adds. "A proper query ensures that appropriate documentation appears in the health record."

Resource: To read AHIMA guidelines on queries, go to: https://acdis.org/sites/acdis/files/resources/Guidelines for Achieving a Compliant Query Practice - 2016 Update.pdf.

Are there CMS guidelines for queries?

Answer: Yes, said Williams. 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

Word on the street is 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 stressed.

Must the query be in writing?

Answer: Written queries are best, but they can be verbal as long as you document the verbal exchange.

Can a query happen over email?

Answer: Yes, as long as your practice's email system is secure and HIPAA-compliant.

What should a query form contain?

Answer: 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.

Word your query carefully so that you "don't box the provider in," Williams instructed conference attendees. 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?

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 some 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 cautioned, 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 to query:

• Please provide the patient's condition necessitating the infusion of the 1000ml of normal saline administered.

To get more tips on query writing and test your skills, check out You Be the Coder on p. 93.

Because queries take up staff and provider time, they can cost my practice money if we must cover the same topics over and over again. How can we educate providers so that we don't have to query them as often?

Answer: Most providers dislike queries too, so you and the coding team should communicate to them that the ultimate goal of your query program is to reduce the need for queries in the first place. Williams recommended that 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 agree rate- "Be wary of the provider who agrees with the coder's query 100 percent of the time," Williams cautioned.

The query tracking can help you discern patterns that will help you build your CDI program. For example, 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 that includes better documentation, less back-and-forth time wasted, faster claims submissions, reduced denials, and fewer appeals.