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Perfect Your Provider Query Skills With These Pointers

Published on Thu Aug 10, 2023

Perfect Your Provider Query Skills With These Pointers

Ensure documentation integrity and correct coding via clear, concise exchanges.

Having the ability to communicate effectively is a fundamental skill, and how you handle queries to your physicians can be an important part of your professional repertoire. Why? Because good communication boosts teamwork and streamlines collaboration.

What’s more, “if you can establish a relationship with your provider, you’ve done 75 percent of the work in coding and querying,” advised Emily Schmidt Barnette, CPC, CPC-P, CDEO, CPB, CPMA, CRC, CPC-I, during her HEALTHCON 2023 presentation “Communicating with Providers.”

Read on to learn how to maximize your knowledge and efficiency with these helpful tips for writing queries and communicating with the providers you work with.

Grasp the Goal of Querying

From time to time, you may find yourself needing clarification about a physician’s documentation before you feel confident figuring out the appropriate ICD-10-CM and CPT^®codes. Medical coders and billers know this process as “querying the physician.”

Seeking clarification through a query helps you understand what the provider is attempting to tell you, so the clinical picture of the encounter and the patient’s condition is complete and accurate. Becoming more comfortable with querying physicians will give your practice a boost in improving your clinical documentation and having a higher rate of successfully paid claims.

Queries should not:

Question a provider’s clinical judgment
Lead the provider to answer in a certain way
Include the impact on revenue

“The goal of the query is to clarify information in the medical record, improving or increasing data integrity,” says Leonta Williams, MBA, RHIA, CPC, CPCO, CRC, CEMC, CHONC, CCS, CCDS, senior director of education at AAPC. “It should never be about maximizing revenue. If you do all things appropriately or correctly, that revenue maximization will come without you having to risk any compliance issues within your facility.”

Explore 5 Reasons You May Need To Query

You might have to query your provider for any of the reasons below:

Legibility: If you as the coder cannot read and input the information, you will need to query.
Completeness: At times, there may be clinical indicators such as diagnostic labs, imaging, pathology, or prescribed medications found within the patient’s medical record. If they or other elements of medical care are not documented by the provider, you should query.
Clarity: Oftentimes, signs and symptoms may be reported or present in the medical record, but your provider hasn’t established a definitive condition, which could be a reason to query.
Consistency: Consistency involves variances within the medical record. If there are any inconsistencies in the notes from the beginning to the end of the encounter, you need to query.
Precision: Although ICD-10-CM gives us an opportunity for increased specificity in code assignment, to assign codes to the highest level of specificity, we must have matching and supporting documentation.

Review the Different Types of Queries

Queries may be written or verbal and generated in one or more of the following ways:

Concurrent (while the patient is still under treatment)
Retrospective (post-encounter)

“The technique of writing a query is critical in ensuring clear and precise communication to a provider. Make sure that the question you are asking makes sense with the information you are providing as support. I like to use ‘specify and clarify’ in my queries, but any language will work provided the doctor understands the query,” says Vida Rothstein, BSTM, HIT, CCS, CCS-P, RHIT, ICD-10 auditor for Maxim Healthcare Services in South Bend, Indiana.

All queries should then follow the same format, whether written, emailed, or delivered over the phone, stressed Schmidt Barnette. They should:

Be clear, concise, and non-leading;
Contain simple and direct language;
Itemize the clinical indicators or clues from the health record; and
Contain all the patient’s identifying information such as name and date of service, as well as clinical findings with supporting documentation that results in a specific question for the provider.

“It’s important to avoid leading the provider with your language. “You want to avoid saying things like, ‘Please document if you agree that the patient has ____,’ and instead ask questions that will help you narrow down the correct coding,” Smith Barnette suggested. You should ask more specific questions like, “Based on your clinical judgment, can you provide a diagnosis that represents the below-listed indicators?” to get to the correct diagnosis.

It’s essential to use compliant query templates for written and emailed queries, as Schmidt Barnette emphasized during the presentation. This ensures consistency and accuracy in documentation across the entire office.

Important: Queries should be a part of the patient’s permanent medical record — the answers to the queries help support your code assignments.

Learn These Better Ways To Query

Suppose you need to query your otolaryngologist regarding a recent myringotomy with tube insertion. Here are a few examples of questions you might want to ask:

Can you provide more detail about the specific procedure that was performed during the myringotomy with tympanostomy tube placement?
Was the myringotomy performed on the left or right ear?
Were there any complications during or after the myringotomy that should be documented?
Can you provide information about the expected recovery time and any postoperative care instructions?
Were any additional procedures or treatments performed during the same visit as the myringotomy and tube placement that should be documented?
Can you provide documentation of the medical necessity for the myringotomy and any supporting diagnostic tests or imaging studies?

In short, “educating the provider that there are certain circumstances and certain terminologies helps reduce what I call physician query fatigue,” says Rothstein.

Communicate Effectively for Mutual Respect

It’s important to keep in mind that tone is so much of communication. “Always be respectful of their time and highlight the mutual benefits of coding correctly … and don’t lecture. Be personable, don’t be a coder, don’t be a robot who just spits out coding guidelines, it just makes the whole thing easier,” Schmidt Barnette said. She reminded her audience that both the coder and the practitioner bring different skill sets to the table that are mutually dependent upon each other and stressed the importance of encouraging teamwork. Being open to listening, asking meaningful questions, and understanding the value of each other’s time is also key to successfully querying the practitioner.

Editor’s note: Additional information and tips on physician queries can be found at https://assets.ctfassets.net/i7kmp6k7g3x q/1ExcHLvKLG6AZ8Bhm428uw/6bf087d62b8cebb6a82eb334 999bdce1/b2b-2022-asg-facility-whitepaper.pdf.