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 correct answersB. Establishing clinical validation
The most challenging query type is for cli...
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 correct answersB. 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? correct
answersA. 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).
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. correct answersA. 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. correct answersC. 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 correct answersC. 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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