Q&A: Mentioning SOI and ROM in queries

Q: Upon review of some of my old query formats, I noticed that come of them have a standard statement like the ones below:

• “To facilitate accurate documentation of severity of illness (SOI), please clarify the etiology of abdominal pain for this patient based on these clinical indicators. Considerations include (but are not limited to)…”
• “To fully capture the patient’s SOI and risk of mortality (ROM) for this encounter, please render your clinical opinion of…”

As the query should “never include impact on reimbursement or quality metrics,” would mentioning SOI/ROM be a problem?

A: Many organizations place such statements within their queries to promote compliance in the query process and explain the purpose of the query to the provider. The concern you have identified is valid, in that telling the provider that you are asking the question to fully capture the SOI and ROM can be interpreted to mean you are seeking an answer that will impact SOI and ROM in a positive manner.

When writing the 2019 ACDIS/AHIMA query practice brief, we did stress that queries should never indicate an impact on reimbursement or quality metrics meaning providers should see queries as a tool to seek clarification of missing or vague documentation. Severity of illness and risk of mortality reflect risk adjustment and a statement seeking to “fully capture SOI or ROM” can be interpreted as meaning to increase reimbursement. I would avoid such wording.

Queries should be written in a compliant manner meaning the premise of the query should be supported by relative clinical indicators. Queries again are a tool that we use to clarify any discrepancies within the record or to obtain any missing documentation. We often query providers knowing their answer will actually decrease reimbursement, trigger a quality measure or decrease SOI and ROM. Our goal is accurate capture of the patient’s story.

I encourage organizations to simplify their query forms and eliminate any such wording, it is not needed and could be misinterpreted.

Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, CDI education director at HCPro in Middleton, Massachusetts, answered this question. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps, click here.