Developing A Query Process For The Physician Practice Or .

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Developing a Query Processfor the Physician Practice orHome Health Agency Copyright 2008 American Health Information Management Association. All rights reserved.

DisclaimerThe American Health Information Management Association makes norepresentation or guarantee with respect to the contents herein and specificallydisclaims any implied guarantee of suitability for any specific purpose. AHIMA hasno liability or responsibility to any person or entity with respect to any loss ordamage caused by the use of this audio seminar, including but not limited to anyloss of revenue, interruption of service, loss of business, or indirect damagesresulting from the use of this program. AHIMA makes no guarantee that the useof this program will prevent differences of opinion or disputes with Medicare orother third party payers as to the amount that will be paid to providers of service.How to earn one (1) CEU for participationTo earn one (1) continuing education unit, each participant must do the following:Step 1:Listen to the seminar, via Webcast link or audio CD.Step 2:Complete the assessment quiz contained in this resource book.Use the included answer key. Do not return the quiz to AHIMA.Save it for your records.Step 3:EACH LISTENER must ces.html and completethe sign-in form and the seminar evaluation.Step 4:After you complete the evaluation, you will receive your CE certificate whichyou should print for your records. The certificate must be retained by eachparticipant as a record of their participation, along with a copy of their completedquiz.AHIMA http://campus.ahima.orgi

FacultyShelley C. Safian, CCS-P, CPC-H, CHAShelley C. Safian, Chair of the Allied Health Department atHerzing College, is also the Senior Assistant Professor forthe Medical Billing and Insurance Coding program. She iscurrently teaching coding and medical office administrationat both Herzing College – Winter Park (Orlando), Florida aswell as Herzing College Online.Safian is a Certified Coding Specialist-Physician-based fromthe American Health Information Management Association(AHIMA) and a Certified Professional Coder- Hospital from the American Academy ofProfessional Coders (AAPC). She also holds a National Certified Insurance CodingSpecialist (NCICS) designation, as well as that of Certified HIPAA Administrator (CHA).Safian completed her Graduate Certificate in Health Care Management in June 2005 atKeller Graduate School of Management. The University of Phoenix awarded her Masterof Arts/Organizational Management degree in 2002.The Florida Association of Post-secondary Schools and Colleges (FAPSC) named SafianFaculty Member of the Year 2006–2007. Herzing College, Winter Park honored Safianby naming her 2007 Teacher of the Year, and she was awarded the FacultyScholarship Award—First Runner Up for the Herzing College System for 2006.Safian is a volunteer AHIMA Mentor, working with health information managementstudents from all across the country, and sits on the AHIMA Classification PracticeCouncil. She attends local chapter meetings of the Central Florida Health InformationManagement Association (CFHIMA) whenever her schedule permits, and encouragesher students to join her at the Florida Health Information Management Association(FHIMA) Annual Convention every year.McGraw-Hill Higher Education published Insurance Coding & Electronic Claims for theMedical Office by Safian in July, 2005. Her second, third, and fourth books, TheComplete Procedure Coding Book, The Complete Diagnosis Coding Book, and YouCode It! A Case Studies Workbook were published simultaneously in February, 2008.AHIMA http://campus.ahima.orgii

Table of ContentsDisclaimer . iHow to earn one (1) CEU for participation . iFaculty . iiWhat is a query? . 1Why should you query? . 1-2Reasons to query . 3-6How to create a query .6-10Submitting the query .11When to query .12Getting buy-in . 12-13Queries and clinial documentation . 13-14Resource/Reference List .15AHIMA Audio Seminars .15About assessment quiz .16Thank you for attending (with link for evaluation survey) .16Appendix.17Web Resource ListSample Physician Query FormAssessment QuizCE Certificate and Sign-in InstructionsQuiz Answer KeyAHIMA http://campus.ahima.org

Developing a Query Process Notes/CommentsWhat is a Query?Query To Askofficial query is defined as a questionpresented to a health care provider in aneffort to gain additional documentation sothe HIM professional can more accuratelyassign a code or codes. An1Why should you Query?“Ajoint effort between the health careprovider and the coding professional isessential to achieve compete andaccurate documentation, codeassignment, and reporting ofdiagnoses and procedures.”ICD-9-CM Official Guidelines for Coding & Reporting2AHIMA http://campus.ahima.org1

Developing a Query Process Notes/CommentsWhy should you Query? Centers for Medicare and Medicaid Servicessupports the use of query forms as a supplementto the health care record.“Use of the physician query form ispermissible to the extent it providesclarification and is consistent withother medical record documentation.”3Why should you Query? Office of the Inspector General (OIG) warns HIMprofessionals against interpreting too far withoutsubstantial documentation, identifying assumptioncoding as a forbidden practice. The OIG definesassumption coding as “Assuming (and coding) from the clinicalevidence on the patient’s record that thepatient has certain diagnoses in theabsence of the physician’s explicitdocumentation of diagnosis.”4AHIMA http://campus.ahima.org2

Developing a Query Process Notes/CommentsReasons to Query? Whenthe clinical documentation is Ambiguous Inconsistent Missingspecificity5Reasons to Query?Ambiguous Information is not clearDiagnosis with no mention in record ofsigns, symptoms, test results, etc. Documentation is illegibleHandwritten notation that cannot be read6AHIMA http://campus.ahima.org3

Developing a Query Process Notes/CommentsReasons to Query?AmbiguousExample:Preprinted encounter form (Superbill)shows check marks for:465.9 URI (upper respiratory infection)81000 Urinalysis, by dip stick7Reasons to Query?Inconsistent Information is not in agreementExample: Attendingphysician documentsdiagnosis of strep throat Pathology report identifiesesophagus tuberculosis8AHIMA http://campus.ahima.org4

Developing a Query Process Notes/CommentsReasons to Query?Missing Information is not completeExample: Physiciandocuments diagnosis ofmalignant neoplasm of the breast9Reasons to Query?Missing Locationwithin the breast ofneoplasm(nipple; central; lower-outerquadrant; etc.) Estrogen receptor10AHIMA http://campus.ahima.org5

Developing a Query Process Notes/CommentsReasons to Query? Missing You must query the physician to have himor her document the specific location of theneoplasm 174.9 Malignant neoplasm of breast(female), unspecified should be an absoluteLAST choice! Unspecified codes are most likely to bedenied or pulled for additional informationrequests (delaying payments)11How to Create a QueryAlways include:Patient name Date of service Health record #/Account # Date query initiated Name and contact information for individualinitiating the query.plus. 12AHIMA http://campus.ahima.org6

Developing a Query Process Notes/CommentsHow to Create a Query.plus Backgroundinformation (clinicaldata from the medical record asapplicable) The Question!13How to Create a QueryFormatting the Question Assure the question does not sound as if itquestions the physician’s judgmentExample“Dr. Jones, the chart shows the patient’s B/Phas been 175/110 the last three visits.Shouldn’t you document a diagnosis ofhypertension?”14AHIMA http://campus.ahima.org7

Developing a Query Process Notes/CommentsHow to Create a Query?Formatting the Question Assure the question is not leadingExample“Dr. Jones, the patient was diagnosedwith anemia and received atransfusion. Please documentidiopathic anemia.”15How to Create a Query?Formatting the Question Open Ended QuestionExample“Dr. Jones, the patient was diagnosedwith anemia and received atransfusion. Please document thecause of the anemia.”16AHIMA http://campus.ahima.org8

Developing a Query Process Notes/CommentsHow to Create a Query?Formatting the Question Multiple choice questionsExample“Dr. Jones, the patient was diagnosed with a closedfractured sacrum/coccyx. Please document: With complete cauda equina lesion With other cauda equina injury With other spinal cord injury Other Unable to determine17How to Create a Query?Formatting the Question Yes/No QuestionExample“Dr. Jones, the pathology reportidentifies the patient may havemultiple myeloma. Do you agree?Yes or No.”18AHIMA http://campus.ahima.org9

Developing a Query Process Notes/CommentsHow to Create a Query?Formatting the Question Verbal QuestionConcern Nodocumentation to support query toprove it was not leading physician toupcode Physician response may never beverbal19How to Create a Query?Formatting the Question Nomatter what make certain thequestion cannot be interpreted to beleading the physician to write adiagnosis influenced byreimbursement level or coverage.20AHIMA http://campus.ahima.org10

Developing a Query Process Notes/CommentsSubmitting the Query Establish office policy Official office query form can be created Should NOT be on sticky note or anythingelse that is easily lost or misplaced Determine if query form is to become partof the official patient record or not Establish preferred response timeframe21Submitting the QueryMethods of transmittal Facility-approved form (paper) Clipped to front of patient chartOn desk/in box/special location Secured Internal e-mail or Intranet Fax electronic systemmachineUse with caution22AHIMA http://campus.ahima.org11

Developing a Query Process Notes/CommentsWhen to Query Concurrent Home care, SNF, LTC Retrospective After patient has left, before claim is submitted Post-Bill After rejection or denial of claimAfter request for more information from payerAfter an audit23Getting the Buy-InEducating clinicians on the value of queries We need to know some things that are intheir heads and were just not written down Physicians do not learn to document forcoding, so they do not know whatspecifics we need Morespecific documentation morespecific codes24AHIMA http://campus.ahima.org12

Developing a Query Process Notes/CommentsGetting the Buy-InEducating clinicians on the value of queries More specific codes Fewer denied claims Fewer claims pulled for determination Optimal reimbursement rates Improved quality of PQRI reporting Higher Physician Quality Report Cards Better resource utilization analyses25Queries and Clinical Documentation“Theimportance of consistent,complete documentation in themedical records cannot beoveremphasized. Without suchdocumentation accurate codingcannot be achieved.”ICD-9-CM Official Guidelines for Coding & Reporting26AHIMA http://campus.ahima.org13

Developing a Query Process Notes/CommentsQueries and Clinical DocumentationQueries help to assure that the clinicaldocumentation can be interpreted in amanner that will gain accurate,appropriate reimbursement for theservices provided to each and everypatient.27Queries and Clinical DocumentationQuality DocumentationQuality CodingOptimal Reimbursement28AHIMA http://campus.ahima.org14

Developing a Query Process Notes/CommentsResource/Reference List ICD-9-CM Official Guidelines for Coding andReporting /ftpicd9.htm#guidelines Federal Register/Physician Querywww.gpoaccess.gov/fr/index.html Office of Inspector Generalwww.oig.hhs.gov29AHIMA Audio SeminarsVisit our Web sitehttp://campus.AHIMA.orgfor updated information on thecurrent seminar schedule.While online, you can also register forlive seminars or order CDs andWebcasts of past seminars. 2008 American Health Information Management AssociationAHIMA http://campus.ahima.org15

Developing a Query Process Notes/CommentsAssessmentTo access the assessment quiz that follows thisseminar, download the seminar’s resource book .htmlYour sign-in form and certificate of completion are also foundin the resource book.NOTE: This slide isreferring to THISresource book.To take theassessment quiz,turn to the end ofthis book.Thank you for attending!Please visit the AHIMA Audio SeminarsWeb site to complete your evaluationform online s.htmlAHIMA http://campus.ahima.org16

AppendixWeb Resource ListSample Physician Query FormAssessment QuizCE Certificate and Sign-in InstructionsQuiz Answer KeyAHIMA http://campus.ahima.org

AppendixWeb Resource ListICD-9-CM Official Guidelines for Coding and Reporting /ftpicd9.htm#guidelinesFederal Register/Physician Querywww.gpoaccess.gov/fr/index.htmlOffice of Inspector Generalwww.oig.hhs.govAHIMA http://campus.ahima.org

SAMPLE PHYSICIAN QUERY FORMDate: TodayCONTACT OF INDIVIDUAL SUBMITTINGQUERY:NAME:PHONE #:E‐MAIL:PATIENT NAME: Joe P. PatientHEALTH RECORD #/ACCOUNT #: JPP1099DATE OF SERVICE: 8/08/08Dear Dr. Ortho :This query is being initiated because the coder needs some additional informationregarding the above patient during the above‐identified encounter.The patient was diagnosed with a fracture of the left humerus. Please document inthis chart the following specifics to enable us to code more accurately.This patient’s fracture is: [ ] Open [ ] Closed [ ] Unable to determine [ ] OtherThe portion of the humerus that was fractured is: Upper endo Proximal end/shouldero Surgical necko Anatomical necko Greater tuberosity Shafto Shafto Lesser tuberosity Lower endo Supracondylaro Lateral condyle (external condyle)o Medical condyle (internal epicondyle)o Articular process/lower epiphysis Other: Unable to determineThank you very much for your assistance.

Assessment Quiz – Developing a Query Process Phys. Practice or Home HealthTo earn continuing education credit of one (1) AHIMA CEU, Fast Facts Audio Seminar listeners must also completethis 10-question quiz. This CE credit is for attending the audio seminar AND completing this quiz. Please keep acopy of the completed quiz with your CE certificate. Do not send a copy to AHIMA.1.Legally, when faced with missing details, thecoder should:a. Figure it out on his or her ownb. Query the attending physicianc. Ask the supervisord. Consult the Merck Manual2.If documentation is ambiguous, it means that itis:a. Missing detailsb. In disagreement with other filesc. Outside of the physician’s scope of practiced. Unclear3.The report states that a chest x-ray was done,two views, without further detail. The codershould:a. Assume frontal and lateralb. Check the patient’s record for previousradiology reportsc. Query the radiologist or attending physiciand. Choose the chest x-ray code that reimbursesat the highest rate4.5.Foam wound cover dressings are coded based onthe size of the pad and whether or not thedressing has an adhesive border. The notes,from the health care professional who appliedthe dressing, do not specify either. The codershould:a. Code for the most common size usedb. Query the health care professional whoperformed the servicec. Send the bill to the patientd. Code for the largest sizeTrue or false? It is permissible to write a query toa physician, in the same office, on a sticky note.TrueFalse6.“Dr. Smith, Please document in the patient’schart that her hemorrhoids were prolapsed.” Thisquery is:a. Leadingb. Legalc. Helpfuld. Efficient7.Dr. Jones requested that queries be sent to himusing his son’s e-mail address: joey@yahoo.com.This method is:a. Not secure and should not be sent this wayb. OK, as long as this is the physician’spreferencec. HIPAA-compliant because it is passwordprotectedd. All of the above8.Queries should not be made:a. Concurrentlyb. Retrospectivelyc. Orallyd. Post-Billing9.More specific documentation enables morespecific codes that does not lead to:a. Fewer denied claimsb. Greater liabilityc. Fewer claims pulled for additional informationd. Optimal reimbursement payment rates10. Querying for clarification in an effort to codemore accurately is supported by:a. OIGb. CMSc. ICD-9-CM Official Guidelinesd. All of the aboveDo not send a copy of completed quizzes to AHIMA. Please keep them with your CE certificate, for your records.Be sure to sign-in and complete your evaluation form, to receive your certificate, .html.AHIMA http://campus.ahima.orgANSWERS to this quiz are found on the last page of theseminar resource book, Practical Tools for Seminar Learning.

To receive yourCE factsresources.htmlclick on the link to“Sign In and Complete Online Evaluation”listed for this seminar.You will be automatically linked to theCE certificate for this seminar after completing theevaluation.Each participant expecting to receive continuing education creditmust complete the online evaluation and sign-in information,in order to view and print the CE certificate.

Quiz Answer KeyFast Facts Audio Seminar: Developing a Query Process for the Physician Practice or Home HealthAgency1: b; 2:d; 3: c; 4: b; 5: false; 6: a; 7: a; 8: c; 9: b; 10: dDo not send a copy of your completed Fast Facts Audio Seminar quiz to AHIMA.Please keep it with your CE certificate, for your records.AHIMA http://campus.ahima.org

Why should you Query? Centers for Medicare and Medicaid Services supports the use of query forms as a supplement to the health care record. “Use of the physician query form is permissible to the extent it provides clarification and is consistent with other medical record documentation.” 3 File Size: 254KBPage Count: 26Explore furtherPhysician Query Examples Journal Of AHIMAjournal.ahima.org2019 update: Guidelines for achieving a compliant query .acdis.orgGuidelines for Achieving a Compliant Query Practice (2019 .bok.ahima.orgThe Physician Query Process Compliance Issuesassets.hcca-info.orgThe Physician Query: What Every Coder Wants You To Knowcapturebilling.comRecommended to you b

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