Question Mark

ICD-10

Physician response rates to queries vary drastically depending on the hospital and its unique CDI program. Are queries posed verbally, on paper, or electronically? Does the facility use query templates? How easy is it for physicians to respond to queries? Does a physician champion play a role in the process?

Only 9.5% of respondents reported a 99%-100% response rate to queries, according to the 2013 Physician Query Benchmarking Survey, published by the Association of Clinical Documentation Improvement Specialists (ACDIS). This statistic indicates that there is definitely room for improvement. Apathy is certainly the worst enemy of any CDI program, and the goal is to get physicians to provide the information necessary for patient care and coding.

Why aren’t physicians responding to queries? Some physicians may be truly resistant to the process; however, others may feel that queries are simply too confusing, complicated, and not catered to their clinical way of thinking.

In February 2013, AHIMA released an updated practice brief, Guidelines for Achieving a Compliant Query Practice, which adds another layer of complexity to which hospitals must comply. To summarize some of the key points, queries must:

  • Be non-leading in nature
  • Include “relevant clinical indicator(s) that show why a more complete or accurate diagnosis or procedure is requested”
  • Include “additional options such as ‘clinically undetermined’ and ‘other’ that would allow the provider to add free text”

To complicate matters, hospitals are currently transitioning to ICD-10-CM/PCS. CDI specialists are extremely busy trying to prepare physicians for that transition by revising query templates and assessing where additional—and more specific—documentation may be required.

Approximately 33% of respondents reported that their facility sets a quota that CDI specialists must meet, according to the ACDIS survey. Of these, 11% report that they are required to query on more than 50% of charts.

The stress is mounting, and it will only continue to do so. It seems evident that hospitals need an effective query process that will get the job done.

Consider Directed Step Queries

The Directed Step Query is a patent-pending process designed with physicians’ needs in mind. It incorporates a coherent, logical series of steps that take the following points into consideration:

  • Identification of appropriate diagnosis to query
  • Consideration of causation, etiology, and potential relationship with other conditions
  • Physician narrative, definitions, and references
  • CDI review and re-review dates
  • Coder feedback

Directed Step queries may be particularly helpful for hospitals with a 50% or lower physician response rate to queries. These hospitals need a fast and effective way to streamline efforts before the tidal wave of ICD-10-CM/PCS takes over. Hospitals that are interested in Directed Step queries should consider the following:

  • What are some of the already-established clinical parameters and definitions that can be used?
  • Will the Medical Executive Committee support the effort? C-suite sponsorship is also crucial.
  • Can resources be allocated to ongoing audit efforts? Queries must be audited for accuracy, relevance, and compliance.
  • Can the hospital supplement the query process with educational presentations for physicians? This will help to reinforce the importance of CDI efforts and ensure compliance going forward.

 Directed Step queries are a patent-pending process and definitely worth consideration as hospitals work to fully engage physicians for ICD-10 preparations.