Question

Case 5-8

Physician Query Policy

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 the problems yourself before the Office of the Inspector General (OIG) finds them. Your task today is to evaluate the physician query process at your facility. Figures 5-1 and 5-2.

1. Evaluate Figure 5-1 on all aspects including the following:

• Good policy and procedure format
• Grammar
• Process

2. Evaluate Figure 5-2 on all aspects, including the following:

• Standards for completion of a proper physician query
• Screen design

HONOLULU GENERAL HOSPITAL Policy Title:               Physician Queries Policy: Physician Queries are used as the sole method of communication between coders and physicians. It should be used when there are problems with incomplete documentation, conflicting diagnoses, recommendation for improvement in medical practices, incomplete histories and physicals, incomplete discharge summaries, improving reimbursement, and other documentation issues. Procedure: Task:                                                                                                           Person Responsible: Review health record to determine principal diagnoses,               Coder secondary diagnoses, principal procedure, and other procedures Complete physician query form in electronic health                     Coder record When query is completed by physician, review physician           Coder feedback and make necessary adjustments to the code assignment Effective date:          May 1, 2017

FIGURE 5-1 Policy and Procedure for Physician Queries            

HONOLULU GENERAL HOSPITAL                                                        Physician Query    Patient Name: _______________________________________________ Dr. ___________________________ Upon review of the health record documentation for the purpose of coding, the following issues were identified: ______________________________________________ Please address the above question(s). If you have any questions, please contact: Coder: __________________ Phone: (___) ___-____ Date: __/__/____ Response: Physician Signature: ___________________________ Date: __/__/____

FIGURE 5-2 Physician Query Screen

Answer 1

1.The format gives information only about diagnosis and procedure.Other aspects are not mentioned.Hence it is necessary to include the following, Patient name, hospital ID, Reason for admission, diagnosis, Laboratory procedures, Medications, Department where admitted period of stay, updated and complete documentation and present health status after treatment.It can in the electronic health record system and must be checked and signed by the physician.If it is in this process the mistakes in coding and billing can be avoided.

2.Not just patient name is enough in hospital setting.It must include the Hospital identification number of the client ,age and diagnosis.The other fields are enough to get information.Hence it need no changes.