? RE: Physician Refusing Retro Queries from Coders

Unknown

Our campus's only hospitalist is refusing to answer retrospective queries. We are following the guidelines for retrospective queries. This physician believes it is fraudulent and sends up red flags for him to document any type of response to queries after the patient is discharged. Can you please assist me with an intelligent response to his misconceptions. This particular query was asking about the clinical significance of his diagnostic statement of a positive blood culture for Klebsiella. I want to give him an intelligent answer that it our responsibility as coders to query. He will answer concurrent queries from the CDI but not coder. He refuses any retrospective queries even for SOI.

Unknown

Physicians often times do not wish to answer retrospective queries due to the misconception of representing fraudulent activity. Reality or not, there is the perception that one is trying to game the system by adding diagnoses after the fact. A suggestion is made to use this incidence as an educational opportunity for the physician based upon the concept of physician medical decision making and application of his/her clinical judgment. The physician's E & M assignment is partly based upon the amount of physician work performed and employment of cognitive skill sets of medicine. Obviously the physician was concerned about an infection if blood cultures were ordered and if they were thought to be clinically significant, then antibiotics were ordered onboard. The culmination of medical decision making and clinical judgment is the arrival of a diagnosis, integral to establishment of medical necessity for the amount of physician work performed in support of the complexity of the case and the E & M assigned. By not including a clinically relevant diagnosis, even if after the fact, detracts from the medical decision making and E & M assignment process.

Hope that helps