Prior encounter support for concurrent query

sally.8494@yahoo.comsally.8494@yahoo.com
in CDI Management

Clear guidance regarding CDI use of prior encounter information (labs, echo, etc.) for concurrent queries is hard to find. In the CDI Pocket Guide: "Clinical data pertinent to the current episode of care from a prior episode may be included in the query citing the source of the information as well as the indicators from the current episode." Does anyone have recommendations or supporting information regarding time limits for how far back to reach for such clinical data?

Thanks for any thoughts or insight!

Sally Hart, RN, CCDS - Vancouver, WA

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Comments

  • lprescott1lprescott1
    stay tuned- We are in the process of writing a new AHIMA/ACDIS Query Practice Brief and I promise you this will be addressed!

    For my own practice, I did look back to further clarify an already written diagnosis- such as CKD or heart failure. (GFR trending and ECHOs) . As to how far you can look back, you need to identify a time period that is considered clinically significant- that might vary depending upon what you are looking for.
  • Jane.Brown@ensemblehp.comJane.Brown@ensemblehp.com
    This is great news!  I also typically looked to prior encounters to query on more chronic conditions such as the CKD and HF that Laurie references above.  I agree with her on time frame also.  With so much information contained in our EMR, I think it only makes sense to include as much concrete information as we can in a query. 
  • jackietouch@aol.comjackietouch@aol.com
    Looking forward to the upcoming practice brief!! There is also a White Paper published on this topic:
    https://acdis.org/system/files/resources/physician-queries-prior-information.pdf. 

    The above reference is from 2015, so having the updated practice brief will be wonderful!

    Jackie Touch, MSN, RN, CCDS, CCM

  • sally.8494@yahoo.comsally.8494@yahoo.com
    All,
    Thank you for your comments. I'm aware that the AHIMA/ACDIS Query Practice Brief is coming, but wanted to see if anyone had any suggestions for a time limit currently especially since the ACDIS white paper lacks such guidance, too. 

    Does this mean most have not set a standard limit for how far back to look? Perhaps this is unnecessary (or counterproductive) given the diverse nature of patient populations and clinical scenarios. 

    Again, thanks for the comments.
    Sally
  • lprescott1lprescott1
    I would suggest that the look back time will change base on the condition you are working to further specify or capture. for example an amputation is not going to grow back or resolve, but a more acute issue might not warrant a longer look back. I think the time must be relevant to the specific issues.
  • slaconis@bch.orgslaconis@bch.org
    With regard to adding specificity to a diagnosis made in an outpatient visit, can a specialist note be used to obtain clinical indicators?  Here is the situation, the PCP coded macular degeneration, unspecified but the eye specialist documented the macular degeneration as wet.  The PCP did state that the patient had received injections for the macular degeneration and it was now stable.  I'm not sure how I would even word the query other than that the specialist diagnosed wet macular degeneration of the left eye. I know this probably isn't compliant!  Any suggestions with regard to either of these questions?
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