Question

CLINICAL CLASSIFICATION SYSTEMS AND REIMBURSEMENT METHODS CASE 2-12 . Physician Query Polity You have suspected there are problems in the physician query process for a while now, and you have planned to review the policy and query form to look for any compliance issues. You would rather find theproblem s yourself before the Office of the Inspect r General (OIG) İ ds iheim Yor task toda, is to evaluate the physician query process at your facility 1. Review Figures 2-1 and 22 for appropriateness. 2 Evaluate the policy and procedure on all apect, including Standards for completion of a proper physician query Appropriate format of the policy Grammar . Form design . Process described . Need to meet discharged not final billed (DNFB) standards

Answer 1

   PHYSICIAN QUERY POLICY

It is a defined as written question to aphysician to obtain additional, clarifying documentation to improve the specificity and commpleteness of the data used to assign diagnosis and procedure codes in the patient health record.

• query a physician to ensure complete and accurate health record documentation.
• query is a vital part of documentation process.

SCOPE: This policy applies to all queries initiated for in patient services provided in the hospital, and all individuals and departments involved in this process including .

but not limited to administration

• ethics and compliance officer
• physician advisor
• case management/quality resource management

WHEN WE DO QUERY A PHYSICIAN

Ensure an appropriate query and also to avoid unnecessary queries. if coding a record is difficult ask patient has any health record.

• conflicting information
• ambiguous information
• incomplete information
• clinically relevant information not adressed
• significant reportable condition or procedure
• lack of clarity present on admission indicator assignment

If you having these you can consider as a physician query.

WHEN WE NOT DO QUERY A PHYSICIAN

• When the benifit is strictly for reimbursement
• when the improvement to data quality is negligible.
• when clinically insignificant findings or irrelevant information
• clinical judgment

POLICY: Hospital medical record departments use the following references to assign diagnosis and procedure codes.

• the official guidelines for coding and reporting diagnosis and procedures
• AHIMA code of Ethics
• joint commission on accreditation of health care organisation standards
• medicare conditions of participation

PROCEDURE FOR THE QUERY PROCESS:

1. Establish facility specific guidelines for when it is appropriate to query eg: clarification of respiratory failure when documentation indicates respiratory distress but arterial blood gases analysis meets or exceeds established thresholds for respiratory failure.
2. Determine if physician will be quired during patient hospital stay or after discharge.
3. Designate a person to initiate the query process-coder, lead coder, supervisor.
4. use of query form to get more information
5. consider various approaches to bring the query to the physician attention. eg: request physician to come medical record department.
6. establish method for incorporating the query information into the medical record by using either
7. determination official document status of the query form.

QUERY FORM

Aquery form should contain at aminimum

• patient name
• admission date
• medical record number
• account number
• date query initiated
• name and contact information of the initiator of the query
• A statement of the issue