Coding, Classification and Reimbursement

Multiple queries same condition

  • 1.  Multiple queries same condition

    Posted 11 days ago
    A CDI submitted the same exact query to the physician on 2 separate dates. He replied to the first and then was sent the query again and he replied again. Problem is his answers are not the same. I'm trying to locate the 'rule' that says you cannot query more than once for the same condition. Can anyone tell me where to find it? Tthanks.

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    Ellen Elia
    RHIT,CPC, COBGC
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  • 2.  RE: Multiple queries same condition

    Posted 11 days ago

    I don't know if there is such a rule..if you can't find it then you need to clarify with doc which answer is accurate..

     

    Sharon Hekimian, RHIT CCS                                                                

    HIM Coder

    Email  shekimia@bidneedham.org

    PH #  781-453-5215

    HOME OFFICE  # 617-312-9205

    FAX # 781-453-5783 ATTN: SHARON

     

     






  • 3.  RE: Multiple queries same condition

    Posted 10 days ago
    I also am not aware of a specific guideline that states multiple queries are not permitted.  For example, if a query was sent to the wrong practictioner, then there would be an expectation to re-send to the correct practitioner.    

    There are however, "best practices" that we want to hold to.    I have seen situations where repeated queries were sent until the desired response was received... (not simply clarifying.. literally asking the same question again till you get a different response).    I think we can all agree this starts to fall into "leading".

    In your case, it sounds accidental, but has created inconsistent information.  That inconsistency would now need to be clarified by an additional query.  





  • 4.  RE: Multiple queries same condition

    Posted 10 days ago
    I agree with Jonathan- however,  there could be another reason for the second query ...trying to achieve continuity within the record -

    As a CDI we continually review for consistency of the conditions treated.   The response to the query may be documented in one progress note, with copy and paste used from a prior note and the information not carried forward.

    Provider education is critical to establish the importance of continuity of documentation within the record (a fallout from copy and paste)
    In this case, the CDI could have rewritten an additional query to address continuity, documenteatio discrepancy to achieve accurate and consistent information.

    As for a "rule" about sending the same query twice -  this may be your facility process - I also do not know of any regulation limiting the number of time a query can be sent.   If there is a discrepancy or additional specificity required a query is indicated.

    I hope this helps -

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    Therese Peyton
    Rn Ccds
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  • 5.  RE: Multiple queries same condition

    Posted 9 days ago
    I believe what you are looking for is in the 2019 AHIMA QUERY BRIEF update. I don't have it in front of me but but says you should not query again when you don't get the answer you were looking for.

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    Sheri Simoni

    Documentation and Coding Compliance Auditor
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  • 6.  RE: Multiple queries same condition

    Posted 8 days ago
    Hello!

    Why would someone issue the "exact" same query after the original one was answered?

    I do not want to question you nor your CDI counterpart.  All I will say is in my current situation there seems to be a problem with CDI issuing unnecessary queries or not issuing queries that should be issued.  They really have no business assigning codes.  I am providing them with coding training.  What do I get?  More work for myself.  When I complain, I get the old "we are a team" speech.  It appears being a member of a team means, when the coder makes a mistake the coder has to fix it.  When CDI makes a mistake, the coder has to fix it.

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    Lawrence Barr
    Coder 3
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  • 7.  RE: Multiple queries same condition

    Posted 4 days ago
    In my own experience, it has happened when a reviewer has a strong opinion about what the answer should be, but the discharging practitioner didn't answer in a way that supported that opinion, so another practitioner was asked in an attempt to get a different response.

    Naturally we escalated and got everyone on board as to what constitutes leading, or questioning the practitioner.  Ideally these events can be positive learning moments

    It's tough because CDI does something slightly different, and may sometimes appropriately write queries that coding wouldn't write.  Sometimes though, the query practice represents a need for education.  The "team" needs to involve both perspectives.  Not just one or the other.    One of the more challenging situations I've faced, involved queries where a CDI believed that infected devices were only a complication if the infection started at the device, but not if the infection spread to the device.  It was based off a misunderstanding of coding rules.  Another was based off the belief that only conditions directly caused by a pregnancy could be OB complications.  All these are ultimately learning opportunities. I think the "team" is best when CDI trusts coding's interpretations of coding guidelines, but the reverse is true... coding should give way to CDI regarding clinical interpretations.







  • 8.  RE: Multiple queries same condition

    Posted 8 days ago
    Good Morning,

    I agree with Jonathan and Therese. I would also like to note that if the CDI professional is sending more than one query concerning the same subject matter in question, then it is just proper and professional protocol that they also for continuity purposes, cite the first, second, etc query for reference and make available this documentation to the physician. In the situation Ellen described, this seems hinky to me. On the border with leading.

    Physicians often don't realize that coding specialists need a specifically documented diagnosis to assign a code especially if the physician believes the documentation clearly identifies the reason for written inpatient order and any concurrent conditions or complications affecting the patient's medical care. Physicians loose site of the fact that coding specialists cannot interpret information In the medical record. Coding specialists and CDI specialists can review the documentation for specific clinical indicators to determine whether a condition may be present and then query regarding the condition to determine if the condition does exist. CDI professionals work with coding specialists and physicians to ensure that the documentation supports assignment of a more specific code. Complete and accurate documentation by physicians is of continuous concern for supporting quality care and also serving as a legal document. The physician's documentation must also support correct coding initiatives, audits, and Medicare oversight reviews.

    I also want to add here that us professionals do not and should not try to bend the physician documentation to the CDI or coder's liking. It is our responsibility to stay educated about disease and its process/progressions and treatment. I find most times in auditing, the documentation is fine; the coder doesn't understand the anatomy or disease process/treatment for conditions.

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    Kelly Randell
    Inpatient Auditor
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