Q&A: Reasonable query response options

Q: I have a question about the guidance in the ACDIS/AHIMA “Guidelines for Achieving a Compliant Query Practice” related to “reasonable” query response choices.

We’re discussing using standardized query templates with consistent options for the provider to determine the appropriate condition based on the clinical indicators we included on the query. For example, consider a case where the clinical indicators support that the patient has chronic kidney disease (CKD) and the provider hasn’t documented the stage. Is it appropriate to provide all of the applicable stages and let the provider determine the accurate stage, even if it was documented in a previous visit? If the CDI specialist limits the answer options to only the answer they feel is clinically appropriate, wouldn’t they be leading the provider to the answer they think is correct?

A: It’s clear you have spent a lot of time reviewing the practice brief and I appreciate your efforts in working to provide a compliant query practice.

We should only provide answers that are clinically supported. So, in the example you gave, we would only include those stages that fit the situation. Providing an answer that is not clinically supported is considered leading. Page 9 of the practice brief says that (emphasis added):

All clinically supported options should be included as well as additional options that permit the provider to craft their own alternate response. Options may include other, unknown, unable to determine, not clinically significant, integral to, or other similar wording.

And,

Multiple choice query formats should include clinically significant and reasonable option(s) as supported by clinical indicator(s) in the health record, recognizing that occasionally there may be only one reasonable option.

Remember, you are also giving the choices of “other” and “unable to determine.” If you aren’t comfortable with offering the appropriate stage (in the case of CKD), you could reword the query to be an open-ended query.

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.