Conflicting diagnosis between query answer and discharge summary

dhedlund1

Our CDI team has encountered an issue I am hoping somebody can advise us on. We have had a couple of clinical validation queries for acute respiratory failure answered as "respiratory failure ruled out". Then, at the time of discharge, the Provider writing the Discharge Summary documented acute respiratory failure as a diagnosis. The acute respiratory failure was coded by the coders who did the final coding and billing.
We are trying to figure out how to clarify the diagnosis (which will likely be a target for auditors) without re-querying the same diagnosis and /or confusing the discharging Provider, who likely did not see the query that was answered "ruled out". We would appreciate any input.

katysuegood@gmail.com

I think you have to query.

We treat out query's the same a progress notes. The DCS is the 'final diagnostic statement' and would take precedent over the query if the query was answered prior to the DCS being written.

I think you have to query, treating the query response and DCS as conflicting documentation. Otherwise, you should code what is in the DCS.

Katy

dhedlund1

Katy, thanks for your reply. Looking at the query as a progress note is helpful in writing another query to clarify the conflict.

stephaniehaase

If the query was constructed with ample clinical evidence to support ruling-out acute respiratory failure, it could be utilized to support the reason the diagnosis was not coded if audited.  Concurrent queries are tricky when the answers are only on the form.  I think reliance on discharge summaries has become a slippery slope which creates more work for coders and physicians.   Let me know how it works out.  
take care 

evanspx@sutterhealth.org

Agree w/ Katy - there is directly conflicting documentation, and the Attending must clarify.

Great question.

Paul

dhedlund1

Thanks for weighing in on this. I have sent queries to the physician who wrote the discharge summary; I will post again when she answers.

dhedlund1

As a follow-up, I did query regarding the conflicting documentation in the query answer and discharge summary. The provider answered that the unsupported respiratory failure I had earlier queried to validate was a actually a valid diagnosis. In other words, reversing the answer to the earlier queries which ruled out the respiratory failure as a diagnosis. So, the documentation ended up coming full circle. At least the queries are part of the patient records so that if reviewed, it will show we did our job LOL!