Q&A: Query formatting—clinical indicators first, or after query?

Q: Our physician advisors are requesting the question and options be listed before the clinical indicators and treatment in the query. I could not locate any direction regarding this format in the current ACDIS/AHIMA physician query practice brief. There are currently differing opinions as to whether providing the options first could be perceived as a leading query. Do you have any advice?

A: Placing the question first, then the clinical elements and treatment that support the query, is a compliant practice. While the 2016 ACDIS/AHIMA query practice brief “Guidelines for Achieving a Compliant Query Practice” does not address this situation directly, it does state the following (emphasis added):

A query should include the clinical indicators, as discussed above, and should not indicate the impact on reimbursement. A leading query is one that is not supported by the clinical elements in the health record and/or directs a provider to a specific diagnosis or procedure. The justification (i.e., inclusion of relevant clinical indicators) for the query is more important than the query format.

Some organizations prefer to pose the question first as it helps busy providers focus and get straight to the issue at hand. The elements that comprise the entirety of the query, including the supporting clinical indicators, determine its compliance, not the sequencing of those elements. 

Ask your providers what they prefer and listen closely to their responses. If your queries are getting too long and cumbersome, consider streamlining them. Provide only the data they need to make an informed decision about a clear, concise question. You may also consider hyperlinking to clinical references (i.e., diagnostic criteria) rather than including it in the template directly. This can help minimize the size/complexity of the query.

The ACDIS advisory board recommends running any changes in query templates or practice past your compliance department.

Editor’s note: This question was answered by the ACDIS advisory board. For further questions, please contact ACDIS Director Brian Murphy (bmurphy@acdis.org).