Querying for CKD when the Labs don't match
Good Morning,
I have a little bit of a dilemma here. I have an MD documenting CKD Stage IV, throughout the record. The lab values only indicate Stage III, with improvement almost to Stage II. How do I send a query for the CKD stage, without appearing to challenge the MD's DX? I don't want the record to come back. Are we allowed to query for "possible conflict" or "incongruence between CKD stage and Current Lab Results"? If so, how would you word the question?
I have a little bit of a dilemma here. I have an MD documenting CKD Stage IV, throughout the record. The lab values only indicate Stage III, with improvement almost to Stage II. How do I send a query for the CKD stage, without appearing to challenge the MD's DX? I don't want the record to come back. Are we allowed to query for "possible conflict" or "incongruence between CKD stage and Current Lab Results"? If so, how would you word the question?
Comments
Since another CKD stage was not documented that conflicts with CKD4, I would not write a conflicting documentation query. This is my rationale:
GFR improvement is possible in CKD stages through 5 but it is accomplished “over time” with decrease in metabolic complication. Without having the entire clinical picture I can’t say for sure if this patient’s change in GFR means a reversal of the progression of the disease. But I like your clinical reasoning.
I am afraid that I am "stuck". I also suspect that the CKD IV will be denied. I appreciate your input.
Or have a conversation with him telling him that according to your references a CKD4 is GFR 15-29 but the patient's current lab values do not jive and ask him on what he is basing his assessment.
Take care to note the staging can impaired if/when renal function is fluctuating.
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Chronic Renal Failure Staging
Please clarify the stage of the patient's chronic renal failure/chronic kidney disease:
Provider Query Response:*
CKD – Unspecified
CKD – Stage 1 (GFR > 90)
CKD – Stage 2 (GFR 60-90)
CKD – Stage 3 (GFR 30-59)
CKD – Stage 4 (GFR 15-29)
CKD – Stage 5 (GFR < 15)
ESRD (End Stage Renal Disease, dialysis dependence)
Unable to determine
Other (please specify)*
You may answer this Query by marking the checkbox(es) above or using free text at the ( * ) if appropriate.
Query:
On (Date) documentation in the (Note Type) section states that the patient has chronic renal failure/ chronic kidney disease.
Clinical evaluation / treatment includes***
The purpose of this query is to ensure accurate coding, severity of illness and risk of mortality compilation. When responding to this query, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected.
Based on the GFR Values that are noted above. The patient is in a "solid" CKD 3 on admission, with GFR closer to 60. Actually ended up with a GFR of 59. I can't query, as the patient was discharged. And, it was felt that querying would be challenging the diagnosis. I thank everyone who commented. And, @paul evans, we use the same GFR staging tool. I wanted to query, but couldn't find a way to do so.
Here is the central issue: The MD has documented CKD Stage IV, which may be a 'CC", impacting billing. Also CKD II does not have the same ROM impact as CKD IV. A review of the GFR (taking care to ensure it is at baseline), indicates CKD IV is not supported, but it is documented.
I posit this is a classic situation for issuance of a Clinical Validation "Query". If CDI does not issue, then coding should. There are excellent guidelines for this process (with query formats) within the White Paper ACDIS just released on the topic of clinical validation.
Paul Evans, RHIA, CCDS
Can you please take the time to familiarize yourself with the policy posted this week by Acdis director regarding proper conduct on Acdis forum.
I am sure your extremely knowledgeable but I can tell you reading these posts, that knowledge is getting lost in translation when it is written in such aggressive and negative posts. I am personally offended by your last post and it is not even directed towards me. I pay a membership fee for this site to learn and grow and enjoy everyone posting their perspective. Your posts do not align with anything that is educating or informative in their current format.