Book excerpt: Queries as physician education tools

Many facilities employ CDI specialists as frontline educators for physician ICD-10 documenta­tion training. Post-implementation, they rely on CDI staff for continuing education efforts. Any number of continued training tactics may prove successful. One such an approach incorporates documentation tips into physician newsletters, presenting targeted education during short PowerPoint presentations, and crafting tip sheets.

Queries are another opportunity to integrate education into existing practices. To do so, review cur­rent documentation trends of your facility’s top 10 to 20 MS-DRGs and review these against documentation requirements. Identify areas for improvement and begin to incorporate these elements into existing physician queries and educational presentations.

At one facility, focus areas included the following:

• Asthma type and acuity
• Atrial arrhythmia type and chronicity
• Respiratory failure type and acuity
• Anemia type and acuity

If physicians already have difficulty fully documenting patient acuity for MS-DRGs, then evaluating the quality of physician documentation and assessing the need for physician education and practical training should be an immediate priority. An assessment of the top diagnosis and/or product lines can help prioritize documentation improvement efforts.

Other query and educational efforts can be identified by analyzing product lines and high-volume services. For example, product lines with more procedure codes might require more specific documentation related to anatomy, device, etc. CDI specialists can conduct a targeted set of reviews for specific procedures to identify documentation improvement opportunities. Note that poor documentation for high-volume services can represent potential risk.

In this post-implementation world, CDI programs need to consistently review their query policies and procedures to ensure compliance and to assess/reassess CDI program successes. Use CDI policies and procedures as a starting point for audits and other reviews. Effective audits will illustrate trends, such as whether records are being reviewed in a timely manner, whether clinical indicators were captured on the query form, and whether the query language was leading or otherwise inappropriate.

Editor’s note: This article is an excerpt from the book The Essential Guide to Provider Queries.