CCDS Compliant Query Formulation 2

Question 1

According to AHIMA/ACDIS query practice guidelines, which of the following query formats is MOST compliant?

Accepted Answer

A multiple-choice query offering clinically appropriate diagnoses plus 'other' and 'clinically undetermined'

Answer

A yes/no query asking 'Does this patient have sepsis?'

Answer

A query that states 'Please document sepsis to support the ICD-10 code'

Answer

A verbal query with no documentation in the medical record

Question 2

Which of the following query scenarios represents an INAPPROPRIATE use of a physician query?

Accepted Answer

Querying to document sepsis when the only basis is a desire to capture an MCC

Answer

Querying to clarify whether anemia is acute blood loss anemia versus iron deficiency anemia

Answer

Querying to confirm whether a wound infection meets criteria for postoperative wound dehiscence

Answer

Querying to clarify the clinical significance of an abnormal laboratory finding

Question 3

When is a verbal physician query considered acceptable under CDI compliance standards?

Accepted Answer

Only when the written query response is also documented in the medical record

Answer

Never; all queries must be in written or electronic format

Answer

For all queries, as verbal communication is faster and more efficient

Answer

For routine coding clarifications that do not affect DRG assignment

Question 4

A CDI specialist sends a query for hypertensive heart disease. The physician responds 'clinically undetermined.' What is the correct action?

Accepted Answer

Accept the response and code without hypertensive heart disease

Answer

Re-query the physician with more specific clinical indicators

Answer

Code hypertensive heart disease anyway based on clinical indicators in the record

Answer

Escalate to the chief medical officer to override the physician's response

Question 5

Which element is REQUIRED to be included in every compliant physician query?

Accepted Answer

Clinical indicators from the medical record that prompted the query

Answer

The specific ICD-10-CM code the CDI specialist is seeking

Answer

The DRG impact of the physician's potential response

Answer

The identity of the insurance payer for the case

Question 6

A hospital's compliance audit finds that nearly all CDI queries result in documentation changes that increase DRG weight. What concern does this raise?

Accepted Answer

The query process may be leading or financially motivated, warranting a compliance review

Answer

The CDI program is performing at peak efficiency

Answer

The coding staff needs additional training on DRG assignment

Answer

The hospital's payer mix likely skews toward more complex patients