Need a refresher on documentation improvement queries?

I get many questions about queries and the query process.   Let me answer a few of these questions to reduce your frustration.

What types of queries are there?

There are at least three types:

1. CDS Query (concurrent query)—This comes while your patient is in the hospital. The distinct advantage here is that nurses write these queries and the patient information is fresh in your mind since it is concurrent with the hospital stay.
2. Coder Query (retroquery)—This is for the purpose of documentation improvement.You get a coder query only after the patient has discharged. Coders are not clinical and prefer not to write queries unless absolutely necessary. The query almost always goes to the discharging physician and will become delinquent if left unanswered.
3. Professional Services Query (may have WVPS in the query title)—If you are a hospital- employed provider and you choose a level of service that is not supported by your documentation, the professional billing department may send you a query. Answering this query will help support the correct bill.

Why do you get queries? 

There are several reasons a query is necessary:

1. A diagnosis word is needed because:
   1. Coders can’t code from symptoms only (in most cases)
   2. Coders can’t code from lab results
   3. Coders can’tcode from imaging study results (even though read by a physician)
   4. Coders can’t code from pathology reports (even though read by a physician)
2. Unexplained treatment is given:
   1. Medications on the med list that have no diagnosis associated with them
   2. On-call physician may have treated something overnight but there is no documentation to support it (on call physician does not get queried about this—attending does)
   3. Wording not accepted by CMS—Words like ”renal insufficiency” are not useful.Coders need specific documentation such as acute renal failure, or acute tubular necrosis, etc.
3. Lack of agreement in chart
   1. Two doctors write different diagnoses—If you document one way and a consultant documents another way, you are out of agreement. This query goes to the attending (yes, those are the rules).
4. A diagnosis was written one time only. Was the condition:

1. Ruled out?
2. Ruled in?
3. Resolved?

Who gets the query?

Providers often ask why a query was sent to their inbox instead of someone else’s inbox. Very strict rules govern who gets a query. The query goes:

1. First to the attending doctor or NP
2. If the attending changes, it goes to the new attending (if not yet answered)
3. Discharging physician—If a patient has already discharged
4. Rarely the consultant—Only if the attending says they do not know how to answer
5. How about the PA?  The query does not go to the PA’s inbox, but the PA is encouraged to answer for their attending when possible. The attending will sign PA notes to legitimize this.

What happens to unanswered queries?

The unanswered query has several paths:

1. It may go to next attending if attending changes and patient is still here
2. If not answered during patient stay, it goes to the inbox of the discharging doc (in this case is sent again by the coder)
3. If not answered within a prescribed period of time, it becomes a delinquency

Important points to remember

1. There are very strict rules as to how, when and by whom queries are written. There is nothing random about it.
2. Queries answered in real time are much easier to answer and take less time because the patient information is fresh on your mind.
3. Unanswered queries delay the billing of a chart up to a month or more.
4. Queries you could/should have answered may be sent to your partner and vice versa!  Be kind to each other and answer your own queries as you would want your partner to do.

If you have other questions, please email me or ask one of the CDS nurses on the floor.