CCDS Compliant Query Formulation 4 — Questions and Answers
Question 1: A CDI specialist wants to query about the specificity of a patient's anemia. Which query format is MOST compliant with AHIMA/ACDIS guidelines?
- A multiple-choice query listing anemia types with a blank for 'other' and 'clinically undetermined' (Correct answer)
- A verbal question asking the physician to pick the correct anemia type from a list read aloud
- A leading statement suggesting 'iron deficiency anemia appears most consistent with labs'
- A yes/no query asking if the patient has iron deficiency anemia
Correct answer: A multiple-choice query listing anemia types with a blank for 'other' and 'clinically undetermined'
A multiple-choice format with 'clinically undetermined' as an option is the compliant standard per AHIMA/ACDIS query guidelines.
Question 2: Which of the following statements about query timing is MOST accurate under compliant query practices?
- Queries may be issued concurrently during the encounter or retrospectively after discharge (Correct answer)
- Queries must only be submitted after the patient is discharged to avoid influencing care
- Queries should be issued only at admission to capture the principal diagnosis early
- Queries are not permitted once a final bill has been submitted to the payer
Correct answer: Queries may be issued concurrently during the encounter or retrospectively after discharge
Both concurrent (during admission) and retrospective (post-discharge) queries are permissible under compliant query guidelines.
Question 3: A query is sent to a physician asking: 'Do you agree the patient has sepsis?' This query is problematic primarily because it:
- Is a leading yes/no query that suggests a specific diagnosis without balanced options (Correct answer)
- Uses the word 'agree,' which is not a recognized medical term
- Should have been sent to the attending of record, not the treating physician
- Does not include the patient's MRN in the query header
Correct answer: Is a leading yes/no query that suggests a specific diagnosis without balanced options
Leading yes/no queries that suggest a specific answer are non-compliant because they bias the physician's response.
Question 4: Under AHIMA's 2019 compliant query guidelines, which of the following must be included in every written query?
- Patient name, account number or date of service, and the clinical indicators supporting the query (Correct answer)
- Physician's DEA number, patient insurance ID, and estimated MS-DRG impact
- A signature line for the physician to attest to medical necessity
- The CDI specialist's credentials and the anticipated reimbursement change
Correct answer: Patient name, account number or date of service, and the clinical indicators supporting the query
AHIMA guidelines require patient identifiers, relevant clinical indicators, and a clear question with balanced response options.
Question 5: A CDI specialist documents in the query that clarifying a diagnosis to 'acute kidney injury' will increase reimbursement by $4,000. This practice is:
- Non-compliant because queries must not reference financial impact or DRG changes (Correct answer)
- Compliant if the physician is also informed of the clinical rationale
- Compliant because transparency about reimbursement supports accurate coding
- Non-compliant only if the amount exceeds $1,000 under OIG guidelines
Correct answer: Non-compliant because queries must not reference financial impact or DRG changes
Including financial impact or DRG information in a query is non-compliant and can constitute improper influence on physician documentation.
Question 6: Which scenario represents an APPROPRIATE use of a retrospective query?
- Querying after discharge when clinical indicators in the record suggest a condition that was never explicitly documented (Correct answer)
- Querying after discharge solely to upgrade the DRG to improve hospital reimbursement
- Querying a physician to change a diagnosis that a coder personally disagrees with
- Querying to add a secondary diagnosis already captured and coded during the concurrent review
Correct answer: Querying after discharge when clinical indicators in the record suggest a condition that was never explicitly documented
Retrospective queries are appropriate when the medical record contains clinical evidence of an undocumented condition affecting coding accuracy.
Question 7: A physician responds to a query by writing 'per CDI' next to a newly added diagnosis. The CDI specialist should:
- Ask the physician to re-document using their own clinical judgment without referencing the CDI query (Correct answer)
- Accept the response because the physician did sign the entry, making it legally valid
- Route the chart to compliance for automatic review since the physician responded
- Code the diagnosis as documented because any physician attestation is sufficient
Correct answer: Ask the physician to re-document using their own clinical judgment without referencing the CDI query
Physician responses must reflect their own independent clinical judgment; 'per CDI' suggests the documentation may not meet compliance standards.
CCDS Compliant Query Formulation 4
A CDI specialist wants to query about the specificity of a patient's anemia.
Which query format is MOST compliant with AHIMA/ACDIS guidelines?