Nine tips to help improve physician queries

April 1, 2011

CDI specialists and their coder counterparts may pose hundreds-even thousands-of queries throughout their careers. One thing remains constant; there's always room for improvement. How can CDI staff and coders write more effective queries and essentially get more bang for their buck? A number of experts offer the following advice:

Tip 1: Keep it short and sweet. "I think what grabs a physician's attention is a query that's clear, fact-based, and direct," says Gail B. Marini, RN, MM, CCS, LNC, manager of clinical documentation at South Shore Hospital in Weymouth, MA. "I think when it gets wordy, or it looks as though there's a paragraph to read, the query is often ignored."
Jean Stone, RHIT, CCS, coding manager at Lucile Packard Children's Hospital at Stanford in Palo Alto, CA, agrees. "A compliant query can be created without filling up a full page with unnecessary verbiage, and we've had better success with shorter-not longer-queries," Stone says.
Tip 2: Keep it compliant. Queries should comply with AHIMA's practice brief "Managing an Effective Query Process," says Stone. The brief is available at http://tiny.cc/2a9hv.
Tip 3: Make it obvious. Queries should be easy to identify (e.g., use colored paper rather than white paper) and should clearly reference a tab in the record that points to the exact progress note and date for which the query is relevant, says Marini.
Tip 4: Include official coding references. For problematic diagnoses (e.g., urosepsis), include Coding Clinic references that briefly explain how physician documentation affects the final coding, says Marini. "Giving a reference shows a reason why this information is needed, and it validates why you posted the query," she explains.
Providing physicians with follow-up articles about the effect of documentation on coding can also be helpful, says Stone. "I've written articles for our medical staff publications regarding the benefits of comprehensive, accurate coding which results in optimum severity-of-illness and risk-of-mortality levels through the APR-DRG classification system," she says.
Tip 5: Send follow-up e-mail. "My staff members e-mail physicians anytime they enter a query on the chart. This seems to work reasonably well," says Stone.
Tip 6: Introduce yourself to physicians. Set aside time during departmental meetings when those who might be querying physicians can introduce themselves and explain that they will be asking for documentation clarification, says Donna D. Wilson, RHIA, CCS, CCDS, senior director of Compliance Concepts, Inc., in Wexford, PA. Coders should only attend meetings specific to their department, she says. For example, if two coders are assigned to the surgical unit. Only those two coders and the coding manager should attend the surgery department meeting.
Staff members may need to reintroduce themselves to physicians even after the initial introductions at departmental meetings, says Wilson. "Keep in mind that physicians are super busy and have a lot on their minds," she says. "If you get a negative response, don't take it personally," Wilson says.
Tip 7: Create a collaborative coder/CDI relationship. CDI specialists can alert coders regarding when certain physicians are typically on the floors. They also may be able to help coders author a more clinically based query, says Marini.
Tip 8: Make friends-not enemies. "Start daily conversations with physicians even if you don't have a query," says Wilson. "A simple ‘Good morning!' goes a long way."
Tip 9: Mind your manners. Queries should always include a "thank you." This small gesture helps maintain relationships with physicians, advises Marini.