The most challenging type of provider query is issued for:
A. Determining cause and effect
B. Establishing clinical validation
C. Resolving documentation conflict
D. Clarifying acuity or specificity
B. Establishing clinical validation
The most challenging query type is for clinical validation and may best be addressed by clinical
documentation specialists (AHIMA 2019c).
A patient was admitted with Type 1 diabetes with proliferative diabetic retinopathy to have
surgery for traction retinal detachment for macular edema. Which of the following questions
would make a compliant query for this patient?
A. Was the procedure performed on the left or right eye or bilateral eyes?
B. Is the retinopathy a complication?
C. Will you document use of insulin for this patient?
D. Is there a comorbid condition that can be documented to increase the reimbursement?
A. Was the procedure performed on the left or right eye or bilateral eyes?
Queries cannot be leading, include impact on reimbursement, or direct a physician to include a
specific diagnosis. Therefore, clarification of which eye the procedure is on is the only compliant
query question (AHIMA 2019c).
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A patient has findings suggestive of chronic obstructive pulmonary disease (COPD) on chest
x-ray. The attending physician mentions the x-ray finding in one progress note but no
medication, treatment, or further evaluation is provided. The coding professional should:
A. Query the attending physician regarding the x-ray finding.
B. Code the condition because the documentation reflects it.
C. Question the radiologist regarding whether to code this condition.
D. Use a code from abnormal findings to reflect the condition.
A. Query the attending physician regarding the x-ray finding.
A 56-year-old woman is admitted to an acute-care facility from a skilled nursing facility. The
patient has multiple sclerosis and hypertension. During the course of hospitalization, a
decubitus ulcer is found and debrided at the bedside by a physician. There is no typed operative
report and no pathology report. The coding professional should:
A. Use an excisional debridement code as these charts are rarely reviewed to verify the
excisional debridement.
B. Code with a non-excisional debridement procedure code.
C. Query the healthcare provider who performed the procedure to determine if the debridement
was excisional.
D. Eliminate the procedure code all together.
C. Query the healthcare provider who performed the procedure to determine if the debridement
was excisional.
Excisional debridement can be performed in the operating room, the emergency department, or
at the bedside. Coding professionals are encouraged to work with the physician and other
healthcare providers to ensure that the documentation in the health record is very specific
regarding the type of debridement performed. If there is any question as to whether the
debridement is excisional or non-excisional, the provider should be queried for clarification
(Schraffenberger and Palkie 2022, 426- 427).
When creating compliant queries coding professionals should:
A. Query once without further follow up
B. Query multiple times until the desired diagnosis is provided
C. Query once with additional follow up if necessary
D. Query unlimited times until every discrepancy is resolved
C. Query once with additional follow up if necessary
AHIMA's Guidelines for Achieving a Compliant Query Practice instruct that additional queries
may be necessary based on the information provided in the first query response. It is
permissible to issue another query in that circumstance (AHIMA 2019c).
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