Q&A: Query quota standards

Q: Is there a practice/industry standard that requires the CDI staff to write two queries per day?

A: We have heard of some organizations with a quota of 20% of their record review volume resulting in query opportunities and even some with a quota for financial impact as well. Many organizations are struggling with system-wide changes related to the pandemic, having been hit hard financially due to reduced surgical and clinical volumes.

However, there is no industry requirement as to how many queries a CDI staff person needs to create per day. Setting a query quota could lead to non-compliant practices such as staff writing a query to meet that quota regardless of whether it is warranted or not.

That said, take a look at the productivity paper “Set CDI productivity expectations, but don’t look for a national standard.”

If there are productivity concerns, those should be addressed on a case-by-case basis ensuring facility specific considerations are assessed also. For example, do all CDI staff review the same kinds of patients? Are there some who review lower acuity populations with less likelihood of query opportunities?

Generally speaking, query rates will vary by the type of review, the service line, the experience of the CDI professional and the program overall. There is no firm number of queries per day which exemplifies a strong CDI practice.

Audits should be performed to monitor compliance in query practice. These could be peer-to-peer or group activities or conducted by a team lead or manager. In the audit, ask questions such as “Are queries written in a manner complaint with the latest recommendations from ACDIS/AHIMA?” “Were there any inappropriate queries?” “Any missed opportunities?”

I would also suggest taking a look at the ACDIS/AHIMA “Guidelines for Achieving a Compliant Query Practice—2019 update.”

Editor’s note: Heather Pautz, BSN, RN, CCRN, CDI supervisor at Children’s Wisconsin in Milwaukee, Dawn Valdez, RN, LNC, CDIP, CCDS, CDI education specialist at HCPro in Middleton, Massachusetts, and Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CDI education director at HCPro, answered this question. For information regarding CDI Boot Camps, click here.