CDIP Communication and Collaboration 3 — Questions and Answers
Question 1: Which communication technique is MOST appropriate when a physician pushes back on a CDI query they feel is inappropriate?
- Withdraw the query without discussion
- Listen to the physician's concern, explain the clinical and coding rationale, and seek mutual understanding (Correct answer)
- Involve hospital legal counsel immediately
- Resubmit the same query unchanged
Correct answer: Listen to the physician's concern, explain the clinical and coding rationale, and seek mutual understanding
Active listening and clear rationale-sharing help resolve disagreements professionally while preserving the physician-CDI relationship.
Question 2: A CDI team wants to improve query response rates. Which strategy has shown the MOST evidence of effectiveness?
- Increasing query volume across all physicians
- Implementing concurrent queries with real-time education at the point of care (Correct answer)
- Sending retrospective queries only after discharge
- Reducing the complexity of queries to yes/no format
Correct answer: Implementing concurrent queries with real-time education at the point of care
Concurrent queries during the patient stay, paired with real-time education, yield higher response rates and more accurate documentation.
Question 3: When collaborating with case managers on CDI initiatives, what is the MOST important shared goal?
- Maximizing DRG reimbursement only
- Ensuring documentation reflects the true severity of illness to support appropriate care coordination and reimbursement (Correct answer)
- Reducing patient length of stay regardless of clinical status
- Eliminating the need for physician queries
Correct answer: Ensuring documentation reflects the true severity of illness to support appropriate care coordination and reimbursement
CDI and case management share the goal of accurate documentation that reflects true clinical complexity, which supports both care coordination and appropriate reimbursement.
Question 4: A CDI specialist is presenting denial trends to the revenue cycle team. Which data point is MOST relevant to include?
- Number of discharge summaries completed on time
- Percentage of denials related to unsupported principal diagnosis or insufficient documentation (Correct answer)
- Average number of queries per physician
- Total number of patient days
Correct answer: Percentage of denials related to unsupported principal diagnosis or insufficient documentation
Denial data linked to documentation gaps directly demonstrates CDI's value to the revenue cycle team and guides targeted improvement.
Question 5: Which of the following is an example of a COMPLIANT CDI query format according to AHIMA and ACDIS guidelines?
- 'Please add sepsis to this record to increase the DRG weight.'
- 'Based on the clinical indicators noted, can you clarify whether the patient's condition represents sepsis, SIRS, infection, or another diagnosis?' (Correct answer)
- 'The coder needs a diagnosis for the elevated WBC.'
- 'Please document acute respiratory failure as the principal diagnosis.'
Correct answer: 'Based on the clinical indicators noted, can you clarify whether the patient's condition represents sepsis, SIRS, infection, or another diagnosis?'
Compliant queries are clinically based, offer multiple diagnostic options, and do not suggest a specific answer for financial gain.
Question 6: A CDI program wants to reduce physician burnout from excessive queries. What is the BEST approach?
- Eliminate all queries that do not directly impact DRG weight
- Prioritize high-impact queries based on clinical indicators and educate physicians to reduce recurring gaps (Correct answer)
- Limit CDI review to the discharge summary only
- Have coders submit all queries instead of CDI specialists
Correct answer: Prioritize high-impact queries based on clinical indicators and educate physicians to reduce recurring gaps
Targeted, high-impact queries combined with education to prevent recurring gaps reduce query volume while maintaining program effectiveness.
Question 7: How should a CDI specialist handle a situation where a nurse practitioner (NP) documents a diagnosis that conflicts with the attending physician's note?
- Use the NP's diagnosis for coding since it is more recent
- Flag the discrepancy and query the attending physician to clarify and reconcile the documentation (Correct answer)
- Ignore the conflict and use whichever diagnosis has a higher DRG weight
- Contact the NP only and ask them to remove their note
Correct answer: Flag the discrepancy and query the attending physician to clarify and reconcile the documentation
Conflicting documentation must be resolved by querying the responsible provider; the attending physician's clarification takes precedence for coding purposes.
CDIP Communication and Collaboration 3
Which communication technique is MOST appropriate when a physician pushes back on a CDI query they feel is inappropriate?