Compliant Query Formulation Flashcards
7 cards from real CCDS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Compliant Query Formulation flashcards as text
When querying about the type of heart failure, which response option MUST always be included in a compliant multiple-choice query?
Answer: Clinically undetermined
Every compliant multiple-choice query must include 'clinically undetermined' to allow the physician to indicate that the condition cannot be specified.
A query asks a physician: 'Based on the elevated creatinine, BUN, and oliguria, does the patient have acute kidney injury?' This is an example of a:
Answer: Compliant query because it presents clinical evidence without steering toward a specific answer
Presenting objective clinical indicators (labs, vitals, symptoms) to support the query is compliant when no specific answer is implied.
Which action by a CDI specialist most likely constitutes 'query harassment' under professional guidelines?
Answer: Sending repeated queries to the same physician on the same encounter after receiving a 'clinically undetermined' response
Requerying a physician on the same issue after receiving a valid 'clinically undetermined' response is considered query harassment and is non-compliant.
A CDI specialist notices a physician documents 'urosepsis' in the record. Under ICD-10-CM coding guidelines, the appropriate next step is to:
Answer: Query the physician to clarify whether sepsis due to a urinary tract infection or UTI alone is intended
ICD-10-CM guidelines state that 'urosepsis' is not a codeable term and requires physician clarification to distinguish sepsis from UTI.
Which of the following BEST describes the 'clinical validity' principle as it applies to compliant query formulation?
Answer: A query should only be submitted when objective clinical evidence in the record supports the possibility of the condition being queried
Clinical validity requires that queries be grounded in documented clinical evidence, not assumptions or financial motivations.
A CDI specialist is training new staff on query language. Which of the following phrases is MOST appropriate to include in a compliant query?
Answer: 'Based on the following clinical indicators, can you clarify or further specify the patient's condition?'
A compliant query asks for clarification based on clinical evidence without suggesting a specific outcome or mentioning financial impact.
When a physician responds to a query by selecting 'other — specify' and writes in a diagnosis, the CDI specialist should NEXT:
Answer: Verify the written-in diagnosis is supported by the clinical documentation before coding it
CDI specialists must confirm that any physician-specified diagnosis is clinically supported in the record before it is used for coding.