making new queries

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
I am new to CDI program coordinator in a program that has fallen apart in the last couple years due to staffing issues. When I started we had some query templates and I am cirrently working on more.
I am basically making templates for different diseases that we can input specific patient data (which I think is fairly standard). Our queries ARE a part of the permanent medical record. The physician liason is looking them over and then they will have to be approved by legal (and every other person!) before we can begin using them.

Is this normal? I keep reading about people coming up with queries for specific patients and being able to use them immediately. Is that because tehy are not a part of the medical record at your facility or are you just given free reign to make queries as you see appropriate without having them approved by anyone else?

I find myself coming accross insufficient documentation that I dont have a written query available to help resolve. We do not have great communication with the Dr's as of yet (working on that!)and they have made it very clear that they want a written query. Therefore, certain things I am unable to do much about because of the lack of flexibility with the queries.

Just wondering what other people have to do to make new queries?

Comments

  • Unknown
    edited May 2016
    We utilize a set of 'standard' queries. One of them is a 'general' query which is used when one of the others does not fit the situation.

    Our standard queries go through a stringent process (legal and compliance) before we get them.

    Do your coders have any queries they currently use? You could use them until yours are approved.

    Charlene
  • robert.hodges2robert.hodges2
    edited May 2016
    All my queries are reviewed by compliance and approved through the compliance committee. That way more than my eyes are looking at them and I can indicate on the form that they were approved by compliance. I do have a "general query" form I use for situations where nothing else quite fits and it does get used rather frequently, as you mentioned, for missing elements in a note or history and physical. I just have to be careful how I word things. Our medical staff by-laws indicate what is supposed to be in a H&P so if something is missing, I use that as my reference and simply ask if they are able to address this issue.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
  • dvitalone1dvitalone1
    edited May 2016
    Our program just started last August. I had to go through approvals for queries also. Check with your coding supervisor. I made queries then found out that the coders already had some in place. Our queries are part of the medical record also. We have the following queries: anemia, chf, pneumonia, functional quadriplegia, altered mental status, sepsis, exc debridement, POA, renal, resp failure, chest pain, malnutrition, uti/urosepsis. We will be going completely electronic by end of year and from what I understand some of these queries will no longer exist. We also have pre printed queries that are not part of the record and we place them on the chart with the hopes that the physician will respond in the progress notes what we are asking. At conference it was mentioned on several different occasions that queries should be part of the permanent record. I hope this helps and good luck!

    Dawn
  • dbutlerdbutler
    edited May 2016
    Great suggestions from several foks to look to your coding peers / team mates.

    We don't use templates -- all of our's are written from scratch (though the common queries sound very much alike after practice). More from an efficiency perspective, we are working on developing some templates for the most common queries.

    I like the way one can carefully craft and customize the query to the specific patient....the balance is of course whether that generates increased risk & how to ensure appropriate practices (training, education, experience & oversight).

    Custom queries from scratch are done the same for both concurrent CDI and post-discharge coding queries -- however the concurrent queries are kept as business documents (not part of the legal medical record) while the post-discharge are included. Part of the reasoning is that we will not use any documentation provided concurrently unless it is in HP, PN, DCS, etc -- not on a paper query or in response to the in-basket query (we present via both avenues).
    FYI -- we are starting to have active discussions centering around the query process topic for several reasons, so this practice may (likely) change in some form or fashion.

    Don
  • Unknown
    Our queries consist of generic (Principle, Secondary, Present on admission) and some disease specific.

    We are always very careful in the wording of our queries and ask for the "clarification" from the physician.

    We list the clinical data first and any documentation in the medical record that leads us to have the question. We then ask him to clarify if he agrees. We do not lead. We give choices in our queries.

    We call our queries "doc-reminders". They are printed on lime green paper. They are not part of the permanent medical record.

    Most of the CDI's choose to use the generic queries for everything because it can be more accurate and more concise to the physician and we find the physician reads and responds to these better.

    If you have any questions, I will be glad to help further.
  • katysuegood@gmail.comkatysuegood@gmail.com
    Thankyou for all the responses!

    Coders are currently using our query forms (whole separate problem!) so they do not have other queries I can access.

    I understand the benefit of having the queries as templates and reviewed by legal, i just wish it wasn't so time consuming. I recently made approx 10 new query forms and it is taking weeks to go through everything that is needed to get them approved!

    ugh...
  • paxnerospaxneros
    edited May 2016
    Don,

    How long and in what manner are you storing your queries? We've been trying
    to decide how long we should keep our queries (they are not permanent) and
    also how to store them.

    Thanks,

    Norma Brunson, RHIA, CCDS
  • paxnerospaxneros
    edited May 2016
    We also have templates for most common diagnoses. One of these is a
    "general" query to use when no other query will work.

    I do construct some queries on my own occasionally - always striving to use
    the guidelines posited by AHIMA. Most of our queries have to do with MCC's
    or CC's, so for clarity or specificity of documentation I will create a
    query for that case.

    All our queries are Word documents which can be edited and created for each
    patient.

    I often use quotes from consultations, the H&P, ER Report and occasionally
    the Radiology report. And all of our queries present clinical indicators as
    well as the question we have in documentation clarification.

    N.Brunson, RHIA, CCDS
  • paxnerospaxneros
    edited May 2016
    I forgot to ask another question...

    Does anyone print their queries on a special color paper to draw attention?
    Or tag it?

    One of our Hospitalists told us that another hospital he worked at printed
    their queries on blue paper.

    Anyone?

    Thanks,

    N. Brunson, RHIA, CCDS
  • dbutlerdbutler
    edited May 2016
    (Ideally) the most recent worksheet & query are kept on the paper chart. At discharge, when the paper record is scanned into the legal medical record, the CDI worksheet & query are scanned also but are placed into a 'folder' into the record along with other business documents (that are not part of the legal medical record).

    In this way, any specific case can be checked and the document retrieved.

    Also, since the coders only are coding from the complete LMR that resided in the scanned system (EMR and paper elements both land there), they also can review the most up to date worksheet.

    I am afraid I don't have any suggestions on how long to keep. One (first) thought is since RAC can look back 3 years, and I know that most or all RACs are asking for queries to be included.....

    Don
  • dbutlerdbutler
    edited May 2016
    We would flag with neon colored arrow shaped sticky notes......since printing on nursing units (from wireless laptops) with 900 beds we could never manage to print to color paper.

    If possible, I strongly support colored paper -- many indicate that is a helpful factor (at least for queries, not so much the CDI worksheets)

    Don
  • paxnerospaxneros
    edited May 2016
    Don, do yoou advocate any highlighting of text? I'm not speaking of highlighting the answer you wish the to document but "wading" through some of the query text and hitting the highlights?

    Seems at the follow Q&A they mentioned not high-lighting but were they referring to high-lighting the documentation you wanted from them??

    We also work from nursing units so it would be hard for us to print on colored paper. I have thought of colored sticky-tabs to mark them. I know which arrow shaped stickies you speak of- that would be useful as well.

    Thank you Don for sharing your ideas!!

    ~Norma
  • dbutlerdbutler
    edited May 2016
    We have highlighted in the body of the question, as well as trying to emphasis the need to respond in the chart (we do use a standard introductory line often asking for additional documentation to be in the PN, etc.). Occasionally I've also seen the entire query equally highlighted -- again, the lack of color paper & a method to attempt to draw attention to the entire question, not emphasis any part.

    Some places have COWs that also have a dedicated printer on a lower shelf -- great solution to be able to use colored paper (or where there is not a robust wireless network). Such solutions are less often needed now with the increasing adoption of EMR's.

    Careful formatting (use of bullets for the clinical indicators/facts/quotes for example) helps in my opinion also.

    I agree, the Q&A context seemed to be primarily aimed at highlighting or pointing to any particular answer when using a multiple choice format, did not seem to be addressed towards highlighting the question. It's always better to have a (carefully compliant) conversation moment, but can't catch everyone all the time.

    Don
  • ggoodman@virginiahospitalcenter.comggoodman@virginiahospitalcenter.com
    edited May 2016
    We use pink paper at our hospital!

    Greta Goodman
    Clinical Documentation Improvement Specialist
    Health Information Management
    Virginia Hospital Center
    1701 North George Mason Drive
    Arlington, VA 22205
    703-558-5336
    ggoodman@virginiahospitalcenter.com
  • kshumpertkshumpert
    edited May 2016
    I have a vertical burgundy stripe that runs down the right margin of my query. I have physician query written inside the margin. When I punch holes in the query, I off set it so that it sticks out of the chart slightly on the right exposing my burgundy physician query stripe.


    Kathy
    Kathy Shumpert, RN, CCDS

    Clinical Documentation Improvement Specialist
    Howard Regional Health System
    Office 765-864-8754
    Pager 765-454-3465
    Fax 765-453-8152

    Words - so innocent and powerless as they are, as standing in a dictionary, how potent for good and evil they become in the hands of one who knows how to combine them. ~Nathaniel Hawthorne
  • Unknown
    edited May 2016
    We use bright green paper for our queries and also flag them with a green
    flag so the physician readily can see the query and know it needs his
    attention. We use this color and no one else at the hospital uses this color-- we
    are known as the "green sheets" ladies.

    It works! Our query response rate is 85-88%.
  • avery.trickeyavery.trickey
    edited May 2016
    We use purple paper. We have been called the purple people eaters

    Our response rate could be better, but the physicians do know who we are because of our paper color.

    Avery E. Trickey, RHIA
    Lead Clinical Documentation Specialist
    Health Information Management
    Advocate BroMenn Medical Center
    309-268-5394
    avery.trickey@advocatehealth.com

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  • twoodstwoods
    edited May 2016
    I use green and am called the green ghost.

    Theresa Woods, MSN, RN
    Jennings American Legion Hospital
    twoods@jalh.com
    Phone: 337-616-7297
  • Unknown
    edited May 2016
    Love this idea! Have a quick question $$$$, what is the cost of your paper compared to plain colored.

    >>> CDI Talk 04/18/11 6:42 AM >>>
    I have a vertical burgundy stripe that runs down the right margin of my query. I have physician query written inside the margin. When I punch holes in the query, I off set it so that it sticks out of the chart slightly on the right exposing my burgundy physician query stripe.


    Kathy
    Kathy Shumpert, RN, CCDS

    Clinical Documentation Improvement Specialist
    Howard Regional Health System
    Office 765-864-8754
    Pager 765-454-3465
    Fax 765-453-8152

    Words - so innocent and powerless as they are, as standing in a dictionary, how potent for good and evil they become in the hands of one who knows how to combine them. ~Nathaniel Hawthorne
  • kshumpertkshumpert
    edited May 2016
    I do this myself with a color copier. I add a text box to the right margin, change the color to burgundy, change the direction of the font to vertical, increase the font size and bold it, and type Physician Query multiple times down the margin. It would just be the expense of the color cartridge and regular paper.

    Thanks,
    Kathy
    Kathy Shumpert, RN, CCDS

    Clinical Documentation Improvement Specialist
    Howard Regional Health System
    Office 765-864-8754
    Pager 765-454-3465
    Fax 765-453-8152

    Words - so innocent and powerless as they are, as standing in a dictionary, how potent for good and evil they become in the hands of one who knows how to combine them. ~Nathaniel Hawthorne
  • david.smithdavid.smith
    edited May 2016
    We have retina scorching "traffic cone" orange query sheets and Day-Glo
    orange Post-if Flags that we write the docs name on and flag the query
    sheet. It's sort of like looking into the Sun! The combo really can't be
    missed, so if it is unanswered then they are just ignoring it .
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