Physician Query Process Flashcards
7 cards from real CDIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Physician Query Process flashcards as text
According to AHIMA and ACDIS guidelines, a compliant query must always:
Answer: Be based on clinical indicators present in the medical record
All compliant queries must be grounded in clinical indicators documented in the medical record to avoid being considered leading or speculative.
Which of the following query formats is generally considered most compliant by AHIMA?
Answer: Open-ended query
Open-ended queries allow the physician to respond freely without being directed toward a specific answer, making them the most compliant format.
A CDI specialist sends a query about malnutrition. The physician responds 'unable to determine.' How should this be coded?
Answer: Do not code malnutrition; use the physician's documented response
The physician's documented response of 'unable to determine' is a valid clinical response that should be respected in coding.
Which of the following is an indicator that a query may be inappropriate or non-compliant?
Answer: The query was generated solely to increase reimbursement without clinical support
Queries generated only to improve reimbursement without corresponding clinical evidence are non-compliant and potentially fraudulent.
What is the CDI specialist's role after a physician responds to a query?
Answer: Communicate the response to the coding staff and ensure it is incorporated into coding
The CDI specialist must share the physician's response with coding staff to ensure accurate code assignment reflects the updated documentation.
Physician queries related to principal diagnosis clarification are most critical because:
Answer: The principal diagnosis drives DRG assignment and reimbursement under MS-DRG methodology
Under MS-DRG methodology, the principal diagnosis is the key driver of DRG assignment, making its accuracy essential for appropriate reimbursement.
Which of the following best describes a 'yes/no' query format?
Answer: A query asking the physician to confirm or deny a specific condition
Yes/no queries ask the physician to confirm or deny a single condition and are considered acceptable when the clinical indicators clearly support that one condition.