Retrospective queries.

sedamala@uic.edu

I just wanted some info regarding retrospective reviews and queries. We get a lot of pushback from our physicians on retrospective queries. The older the chart, the more difficult to get a response. (UNDERSTANDABLY SO) The CDI department sends the retrospective queries on behalf of the coders.

I was wondering if there is any industry standards or facility policy that other organizations/ facilities are using that can guide us as to how old the chart can be (cannot be) for retrospective reviews and querying.

kwilliams

I thank you in advance for any advice that you may offer. Need help with how to code. The patient madeit to the operating room, anesthesia was started, but patient went into atrial fib so the elective TKA was cancelled. Patient was admitted for evaluation of new onset atrial fib. Thanks again.

evanspx@sutterhealth.org

sedamala@uic.edu said:

I just wanted some info regarding retrospective reviews and queries. We get a lot of pushback from our physicians on retrospective queries. The older the chart, the more difficult to get a response. (UNDERSTANDABLY SO) The CDI department sends the retrospective queries on behalf of the coders.

I was wondering if there is any industry standards or facility policy that other organizations/ facilities are using that can guide us as to how old the chart can be (cannot be) for retrospective reviews and querying.

In a nutshell, this should be coordinated with HIM and Compliance.  Issuing a retrospective query can impact MD chart deficiencies, and the reporting of these is regulated by various agencies and credentialing bodies.  Also,  3pd parties have restrictions regarding resubmission of claims after initial billing...so, best course is facility coordination. 

Example:  We can resubmit a claim to Medicare for ‘up to 60 days after the initial date of payment of claim’.   

Paul Evans, RHIA, CCDS

evanspx@sutterhealth.org

Assmuming the admit was for arthritis of knee, the PDX is the knee disease, followed by Atrial Fibrilation. 

kwilliams said:

I thank you in advance for any advice that you may offer. Need help with how to code. The patient madeit to the operating room, anesthesia was started, but patient went into atrial fib so the elective TKA was cancelled. Patient was admitted for evaluation of new onset atrial fib. Thanks again.