Percent of CDIS queries vs. Coding queries

joycolettijoycoletti
in CDI Management
Can anyone tell me what might be a good % of  CDIS queries to Coder queries?  (We are running about 91% CDIS queries to total queries sent - or 9% coding queries)
  
Or better yet:

What is the average # of Coding queries per records coded that would be expected with a mature CDI Program?

During our reconciliation process with Coding we find ourselves wondering why coding did not query on the back-end for clarification on some cases when the CDIS query did not result in clear enough or specific enough documentation for coding.

Also, what is the industry standard for Coding queries related to focus/type of queries sent?   Our coders currently only send a query if it impacts the DRG.

Thanks!

Comments

  • mrh5972mrh5972

    I'm interested in this as well. We have a CDS requirement of 35% and have recently discovered that coding is querying 1%. I would like to know if there is a standard as well. Thanks!

  • christinear17@msn.comchristinear17@msn.com
    Our system has set a goal of 10-20% coder queries for Inpatients. 
  • vbryant@augustahealth.comvbryant@augustahealth.com
    Our CMO is asking for the industry standard on this also.  We currently have approximately an 18% concurrent query rate for a 228 bed facility.  Is there a standard?
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    There is no industry standard because there are  many variables...to name a few:  review for MS and/or APR DRG?  Review HAC, PSI...Readmissions...how long program in place...what software do you use..how well does staff document...what is complexity of care rendered...


    Paul E. RHIA

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    christinear17@msn.com said:
    Our system has set a goal of 10-20% coder queries for Inpatients. 

    Do you find a need to query at of 35%?  Does each query issued address a vital area pertaining to proper billing and/or proper documentation of a risk factor?
    mrh59@att.net said:

    I'm interested in this as well. We have a CDS requirement of 35% and have recently discovered that coding is querying 1%. I would like to know if there is a standard as well. Thanks!


  • jlprinz@att.netjlprinz@att.net
    edited July 2016

    If you have a mature program >8years  -  Would you expect to see the DRG impact rate decline? We have been asked to maintain a 20% DRG impact rate, which we struggle to accomplish.  Our severity rate runs about 46%....

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    I would 'think' the query rate would be expected to decline w/ a mature program.   We have 4 sites, and the rates are different at each as the  complexity differs at each site.

  • mrh5972mrh5972
    paul_evans_90314 said:
    christinear17@msn.com said:
    Our system has set a goal of 10-20% coder queries for Inpatients. 

    Do you find a need to query at of 35%?  Does each query issued address a vital area pertaining to proper billing and/or proper documentation of a risk factor?
    mrh59@att.net said:

    I'm interested in this as well. We have a CDS requirement of 35% and have recently discovered that coding is querying 1%. I would like to know if there is a standard as well. Thanks!


    The 35% is not further specified, which is a big concern to me and my coworkers. At a previous employer, we had clear metrics but not so much here. And this program has been in place for about 10 yrs, so I would expect the query rate to drop. Seems like we're querying to generate a number.
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    I am always concerned if/when administration 'drops' an expected query rate....my prime concern is maintaining clinical credibility and respecting the time of the clinicians.  Good luck...I'd ask, perhaps, how the number was derived?  Certainly 35% for a program in place for 10 years 'seems' pretty high to me...

    Paul E. RHIA, CCDS

  • mrh5972mrh5972
    I completely agree. We have a consultant coming in to evaluate the program and I have hopes there will be real change. I've been a CDS for years and I know this is excessive, but it seems to fall on deaf ears. Thanks for the feedback.
  • mrh5972mrh5972

    The 35% is supposed to be "impactful." I have no idea where they came up with the number, despite the fact that I've asked several times.

  • dvitalone1dvitalone1
    Our system standard for CDI queries is 40% of records reviewed should be queried per 3M reccomendations
  • joycolettijoycoletti
    Thanks everyone for your comments!  I think we got off the main query question a bit, but I found the other comments insightful. My original question was in relation to coding queries, generated on the back end, after discharge.  

    I am very familiar with the recommendations from various consulting groups r/t front end CDIS queries and about 5 years ago I had given 3M my opinion about mature CDI programs and lower query rates
    .  
    Btw, as a mature program (15 years) we maintain close to a 30% question rate on average across our system (it varies from hospital to hospital -11 hospitals of varying sizes/pt. severity) and we have about 30% query impact on average - another words, 30% of all of our CDIS front end queries have a reimbursement impact.  Hope that's helpful.
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