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 this year’s virtual 2020 HEALTHCON, Leonta Williams, RHIT, CPCO, CPC, CEMC, CHONC, CCD, CCDS, gave a presentation entitled, “Outpatient CDI for Oncology and Hematology Services.”

If your Revenue Cycle Management (RCM) department knows how to write effective queries, you can help clinicians improve their clinical documentation and improve your ICD-10-CM coding, Williams notes. 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, conflicting, or lacking in detail. Before you submit a query, make sure you’ve brushed up enough on your clinical skills to understand what you’re reading, Williams stresses. If you submit a query about clinical information you should know, “that lessens your credibility” in your practice.

Send a query when 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 (AHIMA)’s “2019 update: Guidelines for achieving a compliant query practice” (URL: https://acdis.org/articles/2019-update-guidelines-achieving-compliant-query-practice).

“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.”

Are there CMS guidelines for queries?

Answer: Yes, 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

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 stresses.

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 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.

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. 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 agree 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.