Guest post: Queries in real life

By Howard Rodenberg, MD, MPH, CCDS

Do you ever wonder if your professional skills are actually useful in the real world? I know I do. My resume as an emergency physician falls apart when applied outside of the ED, where it turns out you’re not allowed to stare at someone writhing on the supermarket floor with a pseudo-seizure and say, “Stop doing that!” And very few people really want effective CPR when they’re not in cardiac arrest. It’s like a few weeks ago where I noted that my son and I, suburbanites to the core, would probably not fare well amidst the zombie apocalypse as we have no survival skills to speak of. The Dentist Girlfriend (as I call her), who would go shooting with her father Sundays after church and taught me how to change a car battery, simply scoffed at us, noting she would not only survive, but trade tooth extractions for ammo.

However, last week my training in CDI served me particularly well. It was one of those days when things were running late, mostly because I had to wait at home to let in the plumber to fix leaks, drips, and the handles of the bathtub faucet, which is why anyone who heretofore wandered into the master bathroom would have seen a pair of pliers perched on the rim of the tub next to the soothing bath salts.  You’ve got to turn on the tap somehow.

Anyway, because I’m running late and I kind of feel bad about it (I guilt easily), I decided I would be a nice guy and offer to pick up some goodies at Panera for the team.  I reached out to the coding director and our CDI manager to see what I might bring in for them.  The directive came back via text: “One whole grain and a dozen chocolate chip.”

Easy enough, right? So, I walk into the bakery and after the obligatory scan to determine what I want for myself, I ask for a whole grain and a dozen chocolate chip.

“A whole grain and a dozen chocolate chip what?” came the reply from behind the counter.

I’m perplexed. “You know, a whole grain and a dozen chocolate chip of whatever has whole grain and chocolate chips.”

As it turns out, there was only one whole grain product, and that was a bagel. But there are three different products containing chocolate chips, including bagels, muffins, and cookies. And a hectic phone call went unanswered because folks were in a meeting with the Chief Financial Officer and decided not to answer their phones in my moment of crisis. (I sure know who my friends are.)

And it’s here my CDI skills kicked into gear. What do we do when we want to clarify something but are unable to talk directly to the physician? We query for specificity, that’s what we do!

So I carefully constructed a non-leading query:

“Dear Coding Director:

You’ve requested a dozen items from Panera containing chocolate chips. Could you further specify the most likely type of product you desire?

Chocolate chip cookies

Chocolate chip muffins

Chocolate chip bagels

Other

Unable to determine”

In thinking about my solute to this problem, I realized I could probably use queries a lot more often than I do, especially if they were issued in advance. Let’s say that in the morning, my girl and I didn’t know what we wanted to do for dinner that night. We could have six phone calls over the course of the day to discuss this, with multiple changes of mind and no record of who said what when. Or we could just leave this query out on the kitchen table for the last one to leave the house:

“What do you want to do for dinner tonight?

Go out for Mexican

Go out for Italian

Call for pizza delivery

Heat up leftovers

Other (please explain)

Unable to determine. You decide.”

(Here’s the unintentional downside: If this worked the same way as our CDI queries, the credit card company could write to you next week and say that the meal didn’t meet criteria for Mexican, as their board-certified, licensed meal planner has reviewed the charge and found that the meal didn’t meet the criteria for real Mexican food as you declined the offer of guacamole, and therefore your charge should be replaced with ICF (International Classification of Food) code A21.5, “Slightly More Authentic than Taco Bell by Not by Much.”)

Not all queries would be good things, however. Sometimes it’s probably better just to keep things off the record. For example, if a woman is shopping with a man, what happens if she issues the following query?

“Dear Shopping Partner:

Thank you for coming shopping with me. I am trying on an article of clothing. Should I buy it?

Yes

No 

Unable to determine”  

If you’re a woman shopping with another woman, I have no idea what the correct answer might be. But I can tell you with confidence that if you’re a guy, there is no right answer. If you answer yes, she probably doesn’t like the way it looks. If you answer no, she probably really loves it and wants to get it. If you’re unable to determine, you don’t have the courage of your convictions.

The way out of this, of course, is to turn “yes or no” queries over the Magic 8-Ball. For those who don’t know, the Magic 8-Ball is a black plastic ball filled with murky water in which floats a dodecahedron engraved with pithy saying on each side. You ask the Magic 8-Ball a question, turn the ball over, and watch as the answer seems to float up to you and becomes visible through a window in the bottom of the toy. What makes the Magic 8-Ball perfect for “yes or no” queries is that all the potential answers point one direction or the other:

● It is certain● It is decidedly so● Without a doubt● Yes definitely● You may rely on it ● As I see it, yes● Most likely● Outlook good● Yes● Signs point to yes ● Reply hazy try again● Ask again later● Better not tell you now● Cannot predict now● Concentrate and ask again ● Don't count on it● My reply is no● My sources say no● Outlook not so good

The great thing about the Magic 8-ball is that it’s use in the inpatient setting is virtually limitless, as even the vaguest of 8-Ball terms can be thought of as probably, possible, or likely. At worst, you have to ask again later. What a deal.

I think I heard shouting from women’s wear. “It’s not me, darling!  It’s the 8-Ball!”

 Editor’s note: Rodenberg is the adult physician advisor for CDI at Baptist Health in Jacksonville, Florida. Contact him at howard.rodenberg@bmcjax.com or follow his personal blog at writingwithscissors.blogspot.com. Advice given is general. Readers should consult professional counsel for specific legal, ethical, clinical, or coding questions. Opinions expressed are that of the author and do not represent HCPro or ACDIS.