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Medical Coding News Archives

Physician queries abound under ICD-10 – but, know when not to query.

November 10, 2015:

The ICD-10 coding system’s high level of clinical detail is expected to trigger an explosion of physician queries. However, there’s a limit to the number of queries which physicians can or will respond to. Accordingly, queries need to efficiently inform the physician to the purpose of the query and gather the physician response. But, just as important as proper query protocol is knowing when not to query.

In some instances, physicians must make clinical diagnosis decisions which may not appear to agree with test results or other findings. Queries should not question a provider’s clinical judgment, but only seek to clarify documentation for reasons such as legibility or specificity. Queries are not necessary for every unaddressed issue or discrepancy in the medical record; insignificant or irrelevant findings typically do not warrant a query.

An example would be a routine lab test performed after a minor surgery which shows slightly below normal H/H levels. In this case, the provider simply notes the lab results in the progress note even though the patient’s pre-op baseline is unknown and there is no mention of a condition in the progress notes, nor is there any documentation of the need for monitoring or treatment of a condition. This scenario would not warrant a query because the labs were routine and not ordered to monitor or evaluate for a condition.

The 2016 Clinical Documentation Improvement Desk Reference for ICD-10-CM and Procedure Coding contains detailed guidance on physician queries related to ICD-10-CM. For more information about this manual, visit https://www.optumcoding.com/Product/43451/.


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