Post Encounter query for specificity

I supervise risk adjustment coders for an Outpatient CDI post encounter team. I have questions regarding querying providers for specificity of diagnoses with or without certain criteria. For example, if they address and document Depressive Disorder, is it okay to send the provider a query for specificity of the severity, episode and/or status. Or, CKD, if they don't document the stage (whether there is a GFR or not), can we query for the stage. Are there any resources that address querying for specificity? Thanks.


  • Guidelines for Achieving a Compliant Query Practice (2022 Update)

    "b. Do not query if the provider cannot offer clarification based on the

    present health record documentation.

    c. When there is sufficient documentation to assign a valid code and no

    indicators that the code can be specified to a higher degree. Code

    accuracy is not the same as code specificity. The ICD-10-CM Official

    Guidelines for Coding and Reporting’s General Guidelines B.2 only

    requires diagnosis codes to be reported to the highest number of

    characters supported by the documentation, not to the most specific

    code available within the code set.

    d. Queries should only be generated when the clinical data (present and

    relative historical data) fully supports the answer choice(s).

    Some of these are tough especially CKD when there is not a documented history of CKD. There is a new chronic CKD position paper due to be released April 4. You can find it now and it probably contradicts some practices of querying on GFR alone.

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