Question

Case 5.15 Query Analysis (20 points)

Review the following Queries and determine if they are acceptable physician queries. Give the reason for your decision for each case.

3.  Patient name: Tim Smith MRN: 1074567 Dates of service: 09/27/2016 - 09/30/2016

Dr. John Day

Please add pneumonia as indicated in the CXR.

Coder: Doe

4.   Patient name: Margaret Brown MRN: 10897432 Dates of service: 09/27/2016 - 09/30/2016

Dr. Elizabeth Moore

If you will document the BBB in the progress notes we can increase reimbursement.

Coder: Peter

Please provide accurate answers and detailed rationale for each answer. Thank you ( :

Answer 1

In the case of Tim Smith, the query was to add pneumonia in the diagnosis, and they were expressing the concern that it was explained in the x ray. So, if there is an indication of pneumonia can be seen in the chest x ray then it has to be added in the diagnosis and it has to be managed in that direction. So, a positive response can be given that query.

In the case of Margaret Brow, they are asking to add BBB in the progress note to increase the reimbursement, it can be considered completely unethical. If the patient doesn’t have a diagnosis of BBB how it can be possible to add the same. If there is a clear evidence in the investigation and manifestation of the patient having BBB then it can be added, not for any reimbursement purpose.