Tips for revising physician queries

Consider these steps when approaching the oftentimes daunting task of revising queries:

Step one: Inventory all queries. “You may find that some [queries] are no longer relevant, or some are so poorly written that you wouldn’t want to be using them in the first place,” says Cheryl Robbins, RHIT, CCS, director of remote coding operations for Precyse in Dallas, Texas.

Also run a report of most frequently asked queries, says Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, HIM professional in Fremont, Calif.. “How many queries did you send to physicians, and what queries were they?” This will help providers understand the breadth of queries they must update as well as any queries on which they may want to focus, she adds.

Step two: Compare documentation requirements. Compare the language in ICD-10-CM/PCS with that of ICD-9-CM. Diagnoses that are problematic today will likely continue to be problematic in ICD-10-CM, says Robbins. Other diagnoses will simply require more detail. Consider the following: [Note: This is not an all-inclusive list of diagnoses for which query templates must be updated]

• Asthma—Ensure that physicians distinguish between mild intermittent, mild persistent, moderate persistent, and severe persistent.
• Coma—Ensure that physicians document a Glasgow coma scale score.
• Diabetes—Ensure that physicians document the type of cause of the diabetes, specific complications or manifestations, as well as the drug that caused the diabetes (when due to drugs or chemicals). The terms ‘controlled’ and ‘uncontrolled’ are no longer relevant, says Macica.
• Myocardial infarction—Ensure that physicians document the type and site.
• Open fractures—Ensure that physicians document the Gustilo-Anderson fracture classification for certain open fractures (i.e., S52, S72, and S82).
• Pathologic fractures—Ensure that physicians document the exact location of the fracture (site and laterality), the etiology of the fracture, and the encounter type.
• Pregnancy—Ensure that physicians document the specific trimester in which any conditions/complications of pregnancy occur. 
• Hematuria—Ensure that physicians document whether the hematuria is gross, benign, or microscopic.
• Angina—Ensure that physicians distinguish between unstable angina and angina pectoris with documented spasm or other form of angina pectoris. Various inclusion terms are new in this code category. “The descriptors are different, so queries may need to change,” says Bryant.
• Hemorrhage and stroke—Ensure that physicians document specific anatomical location and laterality.

Editor's Note: This article was first published on JustCoding.com.