CCDS Compliant Query Formulation 5 — Questions and Answers
Question 1: When querying about the type of heart failure, which response option MUST always be included in a compliant multiple-choice query?
- Clinically undetermined (Correct answer)
- Congestive heart failure, unspecified
- Normal cardiac function
- Acute-on-chronic systolic heart failure
Correct answer: Clinically undetermined
Every compliant multiple-choice query must include 'clinically undetermined' to allow the physician to indicate that the condition cannot be specified.
Question 2: 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:
- Compliant query because it presents clinical evidence without steering toward a specific answer (Correct answer)
- Non-compliant query because it lists too many clinical indicators
- Non-compliant query because kidney injury queries require nephrologist co-signature
- Compliant query only if the patient's creatinine value is included
Correct 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.
Question 3: Which action by a CDI specialist most likely constitutes 'query harassment' under professional guidelines?
- Sending repeated queries to the same physician on the same encounter after receiving a 'clinically undetermined' response (Correct answer)
- Querying a physician about a diagnosis that appears in only one progress note
- Sending a query that covers two related conditions on the same form
- Using a query template that was not approved by the facility's compliance committee
Correct 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.
Question 4: A CDI specialist notices a physician documents 'urosepsis' in the record. Under ICD-10-CM coding guidelines, the appropriate next step is to:
- Query the physician to clarify whether sepsis due to a urinary tract infection or UTI alone is intended (Correct answer)
- Code urosepsis directly to sepsis since the terms are synonymous in ICD-10-CM
- Code to UTI and add a note that urosepsis was documented
- Escalate to the CMO because 'urosepsis' is a prohibited documentation term
Correct 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.
Question 5: Which of the following BEST describes the 'clinical validity' principle as it applies to compliant query formulation?
- A query should only be submitted when objective clinical evidence in the record supports the possibility of the condition being queried (Correct answer)
- A query is valid as long as it is signed by the attending physician within 48 hours of submission
- Clinical validity means the query format has been reviewed by the facility's legal counsel
- A query is clinically valid when it results in an increased MS-DRG weight
Correct 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.
Question 6: A CDI specialist is training new staff on query language. Which of the following phrases is MOST appropriate to include in a compliant query?
- 'Based on the following clinical indicators, can you clarify or further specify the patient's condition?' (Correct answer)
- 'Please confirm the diagnosis of septic shock to support accurate MS-DRG assignment.'
- 'Documentation of malnutrition would more accurately reflect the care provided and improve reimbursement.'
- 'The current documentation does not support the level of care billed; please revise accordingly.'
Correct 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.
Question 7: When a physician responds to a query by selecting 'other — specify' and writes in a diagnosis, the CDI specialist should NEXT:
- Verify the written-in diagnosis is supported by the clinical documentation before coding it (Correct answer)
- Code the written-in diagnosis immediately because the physician's response is always definitive
- Return a second query asking the physician to choose one of the pre-listed options instead
- Escalate to the compliance department because write-in responses are inherently non-compliant
Correct 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.
CCDS Compliant Query Formulation 5
When querying about the type of heart failure, which response option MUST always be included in a compliant multiple-choice query?