Losing queries

dog

We (5 RN CDS) just had a meeting w/our manager and were told that a dictate has come down that if our queries aren't answered at the time of discharge, if they do get eventually answered, we are not to take credit for having asked a successful query but that the coders are to get credit for the query. This is to be true even if the chart isn't coded for two weeks. We, of course, are very upset about this. If I know a patient is going to be leaving and I see an opportunity to improve the documentation, I shouldn't ask it? Or if I review the chart on Friday, leave a query, the patient goes home on Sunday, and I follow up on Monday to make sure it gets answered, the coder gets credit for the chart improvement? I have even been known to do retrospective reviews on charts to capture short weekend stays, but why would I bother now?

Personally, I think it's ridiculous that we're in competition with the coders to begin with...it should all be a team effort. But this is just insulting. Has anyone ever heard of such a policy?

Not really Jane Doe but don't want my real name on here...

kshumpert

I think that is ridiculous. I don't see how your manager can assume that your coders will catch everything you do nor will you capture the same. The coders at my institution appreciate having an RN to assist them. They don't always pick up on some of the clinical indicators that I find. We have a mutual respect for each other. I question if you will be leaving less queries before the weekend, holidays, etc. I would be hard pressed to leave a query, especially one that would be of great impact only to find it is credited to someone else. It is really difficult when you are in a situation to justify your position to let it fly.


Kathy Shumpert, RN, BSN

Clinical Documentation Improvement Specialist
Howard Regional Health System
Office 765-864-8754
Pager 765-604-0424
Fax 765-453-8152

Proofread carefully to see if you any words out. ~Author Unknown

dallend@einstein.edu

I have never heard of a policy like that. It's one thing if the coder is doing the f/u, but if CDS does the f/u then CDS should get credit.

digardsk

Not only is this ridiculous, but it is very divisive for your "team". If you are tracking data, you must have a mechanism to know who asked the question, and if the documentation improvement is in response to the question.

NormaB

Keep very good statistics while this procedure is in effect. It may prove very useful if you need to look at the value of this edict somewhere down the road.

robert.hodges2

Sounds to me like someone is trying to drive a wedge between coders and CDI's. They should work as a team. The other question I would have is if the CDI generates the query and the provider responds after discharge and the coder never initiated a new one, how can they take credit for a question they never answer?

My personal opinion is you have a leadership challenge going on.

Robert

Robert S. Hodges, BSN, MSN, RN
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
 
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens

Unknown

When I first started HIM Director stated that once a patient was discharged, the query (of the CDS) became the coder's. This was in place for almost 1 1/2 years.

My education goal (for administration) was CDS queries are generated for record completeness, ROM, SOI etc. About a year ago after discussion with CFO, HIM Director, my Director and myself it was decided that the CDS had 48 hours post discharge to complete outstanding queries.

First thing I do each day is check my query list and if discharged get the chart. I hunt those physicians down to get answers. If I miss them rounding, I faxed to their office.

This has worked out fairly well. I now have about a 98% response rate.

Part of the rationale for the extra time was just as you mentioned, Friday queries or queries written on the day of discharge. This allows the CDS the time to interact with the provider.

Charlene

Unknown

We work as a team with the coders. I agree, it should not be a
competition.

Gina Spatafore, RN
Clinical Documentation Integrity Specialist

zahnb

At our hospital, if the clinical documentation specialist initiates the
query, they get the credit regardless of when the query was answered.
If the coder initiates the query retrospectively (i.e. CDS missed the
opportunity to query), the coder gets the credit. Coder queries are
posted differently from CDS queries.

Bonnie Zahn, RHIA, CHP
Director, Health Information Management
Underwood-Memorial Hospital
509 N. Broad Street
Woodbury, New Jersey 08096

Phone: (856) 853-2112
E-Mail: zahnb@umhospital.org

stacy.vaughn

That is the process at our hospital also.



Stacy Vaughn, RHIT, CCS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052

NormaB

This is the way we do things as well, but we report separately. The Lead Coder reports the retrspective queries for the coding department and CDI reports their queries on a separate spreadsheet.

Unknown

We have a separate entry in our reporting/tracking listed as "forward CDI query," even though it is done post discharge, the CDS would get the "credit" for the query, but the coder is instrumental in determining IF the query should get forwarded. I wonder if Administration is really interested in who was successful in getting the DRG changed or SOI/ROM's added as long as it DOES get changed. We may be putting these competitive challenges on ourselves. Our administration always includes coders and CDS's in all correspondence in recognition of a successful month, etc. We just know we all need each other to make it work.

dallend@einstein.edu

We follow the same process.

NormaB

We also do this. It goes in a folder for Coder forwarded query. But the CDS gets the credit if answered.

N.Brunson, RHIA, CCDS

NormaB

Again it goes to quality vs Quantity. In reality the query that makes the most - means the most. Of course any documentation makes a difference because it contributes to the overall quality of the record. But the spreadsheets we are keeping are to show the monetary influences.