Urology Coding Alert

To streamline the querying process, there are some general rules that coders, billers, and practice managers of all specialties should follow to improve communication between office staff and providers. As we’ll see, this is a vital step in the clinical documentation improvement (CDI) process that will expedite the billing process and prevent similar errors in the future.

Query forms should not:

• Be designed so that the only thing needed is a physician’s signature; or
• 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 the Centers for Medicare & Medicaid Services (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. Williams advises that you word your query carefully so that you “don’t box the provider in. Steer clear of ‘leading’ queries that give providers only one way to answer the question.”

Queries should be “non-leading,” even if you think you know what the provider meant to document. You might ask for an addendum or even go as far as providing 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 1000 ml of normal saline administered.”

Look to Education, Workflow

Because queries take up staff and provider time, they can cost a practice money if they repeatedly cover the same topics.

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,” she explains.

Williams recommends practices set up a query tracking form in Microsoft 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;
• Provider response turn-around time; and
• Provider agreement rate. “Be wary of the provider who agrees with the coder’s query 100 percent of the time,” Williams cautions.

Coder’s tip: Natalie Ruggieri-Buzzelli, CPC, CGSC, HIM coding specialist at the Hospital of the University of Pennsylvania outlines the importance of a transparent relationship between coding/billing staff and provider. Furthermore, she outlines a few useful tips to get the most out of your provider queries.

“I prefer to send email inquiries so the provider can reply at their own convenience. When doing so, be sure to keep the email short and to the point; providers don’t typically have a lot of time to read a lengthy email. Lastly, make sure that you proofread and conduct all relevant research prior to sending your inquiry. You not only want to gain the providers trust, but also their respect with well thought out and researched inquiries.