Removing/Rescinding a query?
For those why send queries to specific MD's (not just attached to the general chart), what are your policies/thoughts about retracting/removing queries after they have been placed? Example situations would be:
1. Patient is on our Hospitalist service. A query is sent to MD#1 regarding malnutrition. The next day, you notice that MD#1 is no longer on service and patient is now being managed by MD#2. Can you rescind the original query to MD#1 and re-query MD#2?
2. A query is accidently send to MD#1. This was inappropriate and this is not their patient OR the MD suggests that another MD (maybe a specialist) would be better equipped to respond. Can you rescind the original query to MD#1 and re-query the correct/suggested MD?
3. A query is placed regarding malnutrition for additional specificity (grading). The next day, you see that the MD added the requested specificity to the most recent progress note but has not responded to the query. Is it appropriate to remove the query because it is now unnecessary?
We recently changed from a paper to an electronic query process. With paper, the query was attached to the chart. Any provider could respond when they assumed care of the patient. There was also no post-discharge follow-up. If the Coder decided to re-query a new query was initiated by the coder. With the new process, queries are sent electronically to the provider. It ends up in their message box and they are unable to delete the queries. The only way they can get rid of the query is by responding to it. There is the possibility of the CDI assigning the query to the wrong MD or care being transferred during the stay. There is also a decent chance that the documentation is not actually needed anymore, that it did get responded to in the documentation later on in the patients stay. Also, though there is currently no penalty for unanswered queries (at discharge), they are tracked by HIM and staff will continue to ask them to be answered. Our MD liaison believes that we should only be following up on queries that were not resolved in the documentation at all. Meaning, if the documentation was added to the record, we should not be asking the MD for this info simply to get a response to the query. However, we don’t currently have a way of differentiating between a query that was unanswered but requested documentation was added to the record and one that still requires documentation. Currently, HIM just has an automatic “deficiency†list they receive that includes all queries initiated that were not responded to in the query itself.
FTR, Our queries are a part of the permanent record. If we remove a query, if will still be in the record. It will just now state that its in error and will have a note as to why it was rescinded (Ex: query sent to wrong MD).
I am interested in hearing what others do as well as thoughts about compliance and such.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
1. Patient is on our Hospitalist service. A query is sent to MD#1 regarding malnutrition. The next day, you notice that MD#1 is no longer on service and patient is now being managed by MD#2. Can you rescind the original query to MD#1 and re-query MD#2?
2. A query is accidently send to MD#1. This was inappropriate and this is not their patient OR the MD suggests that another MD (maybe a specialist) would be better equipped to respond. Can you rescind the original query to MD#1 and re-query the correct/suggested MD?
3. A query is placed regarding malnutrition for additional specificity (grading). The next day, you see that the MD added the requested specificity to the most recent progress note but has not responded to the query. Is it appropriate to remove the query because it is now unnecessary?
We recently changed from a paper to an electronic query process. With paper, the query was attached to the chart. Any provider could respond when they assumed care of the patient. There was also no post-discharge follow-up. If the Coder decided to re-query a new query was initiated by the coder. With the new process, queries are sent electronically to the provider. It ends up in their message box and they are unable to delete the queries. The only way they can get rid of the query is by responding to it. There is the possibility of the CDI assigning the query to the wrong MD or care being transferred during the stay. There is also a decent chance that the documentation is not actually needed anymore, that it did get responded to in the documentation later on in the patients stay. Also, though there is currently no penalty for unanswered queries (at discharge), they are tracked by HIM and staff will continue to ask them to be answered. Our MD liaison believes that we should only be following up on queries that were not resolved in the documentation at all. Meaning, if the documentation was added to the record, we should not be asking the MD for this info simply to get a response to the query. However, we don’t currently have a way of differentiating between a query that was unanswered but requested documentation was added to the record and one that still requires documentation. Currently, HIM just has an automatic “deficiency†list they receive that includes all queries initiated that were not responded to in the query itself.
FTR, Our queries are a part of the permanent record. If we remove a query, if will still be in the record. It will just now state that its in error and will have a note as to why it was rescinded (Ex: query sent to wrong MD).
I am interested in hearing what others do as well as thoughts about compliance and such.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Comments
Since queries here are not part of the permanent record, I normally reassign the query to the correct provider and follow up with that person. I will note though if I talked to the provider the original query went to so I can track why the query went to someone else in the event someone should ask one day.
For hospitalists it's too bad you can't send it to the group so that the correct provider providing care that day cannot address the issue without having to generate multiple queries.
Robert
Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
“Patriotism is easy to understand in America; it means looking out for yourself by looking out for your country" Calvin Coolidge
I find your note very interesting as we are headed toward electronic queries in December.
We like the paper queries as you indicated, any provider can answer the query.
We are going to have to have to keep up with the daily hospitalist schedule now to see who we should assign the query to...............what happens if they go off for their 7 days off and the query has not been answered? ......we still do not know if we can get into the electronic query and redirect it.
Also, currently some of our physicians will document the necessary response to the query in the body of the chart...if we have left a query; we close it out and take credit for a response, even if they do not answer on the query form. Our dilemma now will be how to close out the queries if they are no longer appropriate.
You offer some very important questions and thoughts.....I will keep you posted as we journey down this path.
Lisa Romanello, RN,BSN,FNS,CCDS
CDI Specialist
CJW Medical Center
Chippenham Campus
804-228-6527
not appropriate. Don't have to do that too often. If any physician
answers the query we mark it answered and documented!
Jamie Dugan RN
Clinical Documentation Improvement Specialist
Baptist Health System
office:904-202-4345
cellular: 904-237-7253
Business Email-jamie.dugan@bmcjax.com
cdis.icd10@bmcjax.com
In our case, Leadership wants us to take credit for responses in the body of the record. We have always done this so, in our CDI software, we mark them as "answered" if the physician adds the required documentation to a future note. Part of why leadership made this decision is that they do not want us (CDI) harassing MD's for a response just to make sure our "numbers looks good". They only want the MD "bothered" if we are actually missing documentation.
So, what's interesting is that if we pull a list of outstanding queries from our CDI software, it will not match the one that HIM is looking at and they query will remain in the MD's box FOREVER if not directly responded to.
I like our E-query process. But this definitely needs some fine-tuning.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
The declined query goes into a queue which the coder of the CDS can reassign it or retire it with the reason why (no longer valid, answered in the progress note)
This is a new process for us clinical documentation specialists. The coders have been using it for almost a year now. I have not actually used it yet.
Charlene Thiry RN, BSN, CPC, CCDS
Clinical Documentation Specialist
Quality Resources
Menorah Medical Center
So all MD's see your queries once placed? In our system only the provider who is specifically queried can see the query until the provider answers it. Once they answer, it automatically is visible in the record for everyone. So only one provider will know the query has even been placed and be able to respond.
What do you do if documentation is added to the record (progress notes) but the query is not directly responded to?
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
The sad truth....
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
for IT to make it where we can send them to the physicians inbox.
Jamie Dugan RN
Clinical Documentation Improvement Specialist
Baptist Health System
office:904-202-4345
cellular: 904-237-7253
Business Email-jamie.dugan@bmcjax.com
cdis.icd10@bmcjax.com
Yes, we also wanted to have general “hospitalist” and “intensivist” buckets for queries. Unfortunately, the MD’s made it very clear they would not look in another location for a query so we are stuck sending them to their personal boxes.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Good luck Katy J
Robert
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