Simplifying the Query Process: Directed Step Queries · 7th Annual Association for Clinical...
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7th Annual Association for Clinical Documentation Improvement Specialists Conference 2 Simplifying the Query Process: Directed Step Queries Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP, CHITS-CP, MCP Director Auditing & CDI Services TrustHCS
Transcript of Simplifying the Query Process: Directed Step Queries · 7th Annual Association for Clinical...
7th AnnualAssociation for Clinical Documentation
Improvement SpecialistsConference
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Simplifying the Query Process: Directed Step Queries
Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP, CHITS-CP, MCP
Director Auditing & CDI Services
TrustHCS
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Learning Objectives
• At the completion of this educational activity, the learner will be able to:– Describe the issues physicians have with current
query practice
– List the components of a Directed Step Query
– Explain how a Directed Step Query is constructed
– Discuss how to maintain a compliant query process while using a Directed Step Query
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Introduction
• What is a query?– Question to the provider– Non-leading
• Reasons to query– Accuracy– Clarification– Specificity– Conflicting documentation– Supporting documentation
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Why a New Query Process?
• How are queries initiated?– Paper
– EMR
– Hybrid
– Combination
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Why Create a New Query Process?
• Demand from physicians
• Typical query process allows wide variation in responses
• Lack of specificity
• Preparation for ICD-10
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Physician Dissatisfaction With Current Query Process
• Unclear clinical indicators
• Incorrect information
• Not all appropriate diagnoses included
• Causation or relationship to other diagnoses not accounted for
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The Proposed Query Process
• Created with physicians’ needs in mind
• “Beta-tested” for feedback
• Provides an answer to the question, “Just tell me what you want me to do”
• Provides a coherent, logical series of steps through the query
• Does not favor one answer over another
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Directed Step Queries
• Even the title appeals to the KISS principle (Keep It Super Simple)
• Providers are tasked with “steps” to follow to respond to the query
• Standardized format with areas of customization
• Query can be launched electronically or by placing paper query into the record
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The Pieces of a Directed Step Query
• Query title
• Patient demographic information
• Query instructions
• CDI specialist/coder narrative
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The Pieces of a Directed Step Query
• Step 1– Choose a specific diagnosis
• Step 2– Consider causation, etiology, or relationships to
other diagnoses
• Some queries with 3 steps (pneumonia, diabetes)
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The Pieces of a Directed Step Query
• Physician narrative (if space allows)
• Physician accepted definition or reference
• Additional reminder if indicated
• Physician signature
• CDI specialist review/re-review dates
• Coder feedback
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Components of a Directed Step Query
• Query introduction– General clinical information
– Compliance information
– General instructions
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Build a Directed Step Query
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Build a Directed Step Query
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Build a Directed Step Query
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Components of a Directed Step Query
• CDI specialist narrative– Lab values
– Radiology findings
– Medications
– Unclear diagnoses
– Conflicting diagnoses
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Build a Directed Step Query
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Components of a Directed Step Query
• Step 1 – list of appropriate diagnoses– Relevant diagnoses for
condition/syndrome/clinical signs or symptoms
– Logical grouping of conditions
– Specificity to include stages or severity
– Include nonspecific conditions
– Always include options of “other” and “not able to determine”
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Build a Directed Step Query
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Components of a Directed Step Query
• Step 2 – related diagnoses, etiology, or causation– Grouping of conditions
– Always include option of “other” and “not able to be determined”
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Build a Directed Step Query
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Components of a Directed Step Query
• References– If at all possible, use specialist-accepted and
agreed definitions
– Include source information on query
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Build a Directed Step Query
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Components of a Directed Step Query
• Additional reminder if indicated
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Build a Directed Step Query
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Components of a Directed Step Query
• Space for physician narrative (if space allows)
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Components of a Directed Step Query
• Physician signature/date/time
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Build a Directed Step Query
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Components of a Directed Step Query
• Coder/CDI specialist interaction– If CDI query not answered, offers mechanisms for
feedback
– Ability for coder to state if retrospective query placed
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Build a Directed Step Query
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Query With 3 Steps
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Query With 3 Steps
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Query With 3 Steps
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Query With 3 Steps
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Query With 3 Steps
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Query With 3 Steps
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Query With 3 Steps
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Query With 3 Steps
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Query With 3 Steps
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Query With 3 Steps
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Additional Queries
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Additional Queries
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Query Compliance
• Physician participation– Solicit clinical content from relevant specialist
groups
– Use hospital or enterprise clinical parameters and clinical definitions• Approval of medical executive committee
• Query auditing for accuracy, relevance, compliance
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Query Compliance
• Administration support– C-suite sponsor
– CMO agreement
– CMIO agreement
– HIM agreement
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Query Compliance
• “Guidelines for Achieving a Compliant Query Practice” AHIMA/ACDIS brief– Expanded use of checklists
– Guidance regarding yes/no queries
– Clarification for lack of clinical indicators to support a diagnosis
– Open-ended queries
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Conclusion
• Best practice suggestions– C-suite sponsor– Collaboration with coders/HIM– Specialist accepted definitions– Multiple references– Approval/consent of MEC– Forms committee approval– Regular query audits– CDI Specialist certification
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Thank you. Questions?
In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the workbook.
