query metrics

tkreiling

Hi, we are trying to find a way to be consistent with our query metrics amongst all of our CDS staff. We are trying to track what would be an "impact" query vs a "severity" query. How do other programs track this? Do you count a query as an impact query if it really does impact/change the DRG and would you could it as an impact if it could have changed the DRG, meaning adding another cc or MCC even if the patient already has a cc or MCC. Do you count it as a impact query if it could have changed the DRG and the doctor just did not give you the most specific dx, ex. answered CHF, NOS when the treatment and indicators pointed more towards acute systolic CHF? Any suggestions or links on where to find out how best to track list would be appreciated.
Thanks,
Tara, RN, CCDS

renmeyer@sbcglobal.net

We only count it as an 'impact' query when there is a DRG shift causing a financial gain. If there is already another cc or mcc and our query did not cause the DRG to shift that is considered a severity query. So no, we do not consider it an impact query if it could have changed the DRG but there is already another cc/mcc. If the query is geared towards specificity as in the case of CHF it almost always goes to severity, unless sometimes the way it is coded the acute systolic becomes a mcc for CHF (don't ask me how, I'm not a coder), in this case the DRG would change from 293/292 (depending if there is cc's) to 291. That is then considered an impact query. Without us asking if this was systolic or diastolic it would have coded to 293/292.

Hope this helps

Renee, RN
Lead CDS

tracy.boldt

Our CDS mark each query based on the following: Impact(either MCC/CC or SOI/ROM), Educational opportunity and ICD-10 focus.
We have implemented some new queries based on ICD-10 so these will not make an impact however will provide the providers a slow transition to ICD-10 w/out them noticing.

Tracy Boldt, RN BSN
Clinical Documentation ICD-10 CDI Lead
Phone: 612-873-3281

Hennepin County Medical Center
701 Park Avenue South
Minneapolis, MN 55415

bmurphy@hcpro.com

As an FYI, we made this question the poll on the ACDIS website.

tracy.boldt

I should also add we do not take credit for additional CC or MCC if they don't make an impact on the SOI/ROM. In most cases they do but on the rare occasion they don't we don't take credit. On this note also we will not query if the query will not make an impact either financial, cc/mcc, SOI/ROM, ICD-10 concept.

vanessa.falkoff

I really enjoy hearing what other programs are doing!
Our program is a work in process. I currently label our queries by final results of:
Query changed DRG
Query added MCC
Query added CC
Query added MCC n/a DRG
Query added CC n/a DRG
Query added POA information
Query clarified PDX
Educational - improved documentation
N/a - no improvement in documentation

I also track when a query is not needed (QNN) for:
Type of DM
Acute Blood loss anemia
Heart failure
HTN
POA pressure ulcer
BMI

I do a quarterly report for the top 3 which I guess would be considered "impact" queries with the pertinent numbers for length of stay, relative weight and reimbursement.


Vanessa Falkoff RN
Clinical Documentation Coordinator
University Medical Center
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322
cell 702-204-0054

evanspx@sutterhealth.org

Classifications include:

Affected MS-DRG - coder addition of CC/MCC that would not have resulted w/o CDI action

Impact ROM/SOI - clarity in documentation specificity that increased either ROM/SOI alone, but did not impact MS-DRG

Educational - MD documentation clarified as result of CDI, but no MS-DRG impact and/or APR-DRG

There can be obviously be overlap - in my view, one can audit for each/all of these, but accurate verification and reconciliation of each query and category is very, very, very time-consuming, (unrealistic in my particular situation given to work flow and lack of adequate software), if done properly.

Paul Evans, RHIA, CCS, CCS-P, CCDS
 
Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell:  415.637.9002
Fax:  415.600.1325
Ofc:  415.600.3739
evanspx@sutterhealth.org

michelleclyne

I would be interested in knowing the type of queries that are "ICD-10 concept or focus" based. If you would be willing to share, I would appreciate it.


Michelle Clyne, R.N. MSN/MHA
Clinical Documentation Improvement
michelleclyne@catholichealth.net

don.cdi.rn@gmail.com

Like others have mentioned, there are (for us) software capability limitations as well as program size / staffing restrictions. (9FTE's, 900+ beds, review 1550 cases monthly) What I'd like to do and what we are able to do ... different things.

We 'count' all queries when looking at query rates, physician response rates & agree rates.

Our software is designed to be able to (fairly) easily distinguish queries that have potential financial impact (and whether those are aimed at PDX, CC, MCC, Proc, etc.) or not (Severity). We can not collect any more information than that.

We track both total query rate, and impact query rate.
We also track final success -- % of all cases reviewed that we were able to cause financial improvement.

I'd LIKE to collect data for query categorization and success per category:
Additional CC/MCC
Additional specificity
Impact on SOI/ROM
Clinical categories (CHF, PNA, Sepsis, ABLA, electrolytes, Shock, ABLA ...)
etc....

Within the limits of software, staffing, etc., I'd ideally define an impact query as any query that has the potential to either improve specificity of coding &/OR that produces improved documentation needed to support coding, illustration of physician thought process, need for inpatient care, risks, etc.

Practically -- we do as I described above because of existing limitations.

I'd also strongly suggest that you define impact query to be in line with what your formal CDI Policy & Procedures discuss as far as focus, purpose, etc. (you do, of course, have written P&P, yes?).

Don