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Will CDI staff take on larger role in querying physicians?

ICD-10 Trainer, February 24, 2012

Physician queries are considered communications between coding (or coding-related) professionals and physicians to clarify or increase specificity in the documentation to ensure good clinical documentation as well as to support code assignment for the billing process. Queries are technically not limited just to inpatient coding and in some cases can also be done for outpatient or professional services. For the moment, I’d like to focus more on the previous than the latter.

Currently, queries can be performed concurrently or retrospectively to the inpatient admission/discharge. Concurrent queries, which are generally preferred, are posed while the patient is still “in-house” and the physician is readily available to provide clarification while the information is new in his or her mind. Verbal queries are generally included with the concurrent queries. Retrospective queries are performed after the patient is discharged, typically prior to the billing or post-billing. The query responsibility is generally shared by the coding staff as well as clinical documentation improvement (CDI) staff members.

Now on to why I am bringing this up.

Queries performed by CDI specialists traditionally have been mostly limited to diagnoses (and in many cases ones that affect the overall reimbursement), such as complications/comorbidities (CCs and MCCs). But some of these queries have no financial bearing on the case and are simply posed to obtain added specificity to reflect true severity of illness.

We know that with all the added details in the ICD-10-CM diagnosis codes, there very well may be many more opportunities for queries to be posed. But, my cause for concern is that the ICD-10-PCS codes will require a very thorough understanding of how physicians actually perform the procedures and the anatomy involved, which may go beyond the clinical knowledge of coder.

So, will CDI specialists become more involved in the query process as it relates to procedure coding? Procedures can certainly have an impact on the overall MS-DRG assigned, and incorrect assignment can lead to improper overpayments (or underpayments). If a question arises regarding a procedure, would it make more sense for the coder or the CDI specialist to pose it to the surgeon? CDIs are in many cases spread very thin (as coders are as well) and may even find it hard to even touch all the cases more than once or twice from a diagnosis standpoint.

So will it present problems in the future if we add to their workload additional clarifications needed for operative reports? All seven characters must be assigned to qualify as a complete ICD-10-PCS code, so there is no way out by using a vague code with digits/characters identifying “unspecified.”

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