Query Ownership

dvitalone1

 HIM Administration has taken away the ownership of queries from CDI once a patient is discharged. CDI has been instructed that if the query is not responded to prior to discharge, the coders will follow up on the queries.  The coders will also be responsible for marking the query response outcome. We are a 3 hospital system and all 3 CDI departments are upset about this process. I was asked to post this and see what the process is at other facilities. Please response with what your system process is for open CDI queries post discharge. Thank you

katysuegood@gmail.com

at our facility CDI handles all queries concurrent or retro. When coders note missing information CDI is contacted to place the query. CDI is also responsible for all follow-up with providers. We have been doing this for several years. Prior, CDI did not do retro queries but still followed up on open queries that were placed concurrently but were not answered at the time of discharge. The primary reasons we switched to CDI doing all queries was for uniformity, access, and education. Our queries are more consistent if fewer people are placing them, we have better access tot he providers, and CDI's learn about missed opportunities and follow trends. 

evanspx@sutterhealth.org

Two components:  1.  If CDI initiates a query, and needs additional f/u after D/C 2/2 lack of response, then at our sites,  the CDI member retains role in obtaining response.  I view this as logical as 'we' issued the query and are familiar w/ the case.  2.  At our sites,  a CDI member initiates retrospective queries that are typically undertaken for a quality initiative such as cases w/ low ROM or cases coded as sepsis w/o severe sepsis.   A retrospective function is required as it is not reasonable to expect the CDI team to sell all such cases concurrently; hence,  CDI is contacted by Quality Mgr to conduct a retrospective review and query.  hope this helps a bit?

Paul Evans, RHIA

dvitalone1

Thank you Paul

morris-jeff@CooperHealth.edu

We follow our queries until the coder gets the record to code. At that point the coder will mark our query as unanswered and code the record. At that point they will determine if the query is warranted and will issue the query if needed.

Jeff

jackietouch@aol.com

Our process is similar to Jeff's: CDI is responsible for concurrent queries only. Once patient is discharged, CDI indicates that there was no response in CDI software and coder follows up on unanswered queries. We notify the coding lead of the outstanding query at discharge and she notifies the coding team for follow up. 

Jackie

cindys@hollandhospital.org

CDI manages all concurrent and retrospective queries - only CDI initiates queries.

Amy_Stremming_1992

Same at Vanderbilt: CDI handles all queries, both concurrent and retro. We feel this is the best practice for a variety of reasons, but mostly because: the CDI staff are the ones who deal with the physicians and can build rapport with them; our queries are consistently worded and we are up to date on formulating compliant queries; the coders' time is better spent coding charts while queries are CDI's main focus. Several of our coders come from other facilities where they wrote their own queries, and they prefer our process since it gives them more time for coding.

22706208

Seattle Children's Model is a dedicated CDI Coder included in the CDI team

She codes all the charts with CDI queries and follows up on opened queries at the time of discharge. In addition, if the remainder of the record shows the need for a new query, she will send one as well to maximize SOI ROM if need be.

An all EMR record and software tool identifies any chart with a query. These populate on the Coders daily worklist. Other coders will send retrospective queries on charts as needed as well.

evanspx@sutterhealth.org

Love the concept of having a coder dedicated to the CDI team!  I see so many ways this is a win for the CDI team members.

Paul Evans, RHIA

dvitalone1

Thank you all for your input.