Physician queries in 2013

I am back to my ICD-10 blog following a long illness. It is great to be back!

Why is it that a date ending in 2013 seems so much closer to October 2014? Others must feel this way because there seems to be a really flurry of activity at the ICD-10 websites I visit regularly since the new year.  Hopefully, this new year is spurring us to keep moving forward with the ICD-10 implementation we have started.

The new year is a good time to take stock of where you are and to think about what needs to happen in 2013. For the next three weeks I will focus on physician queries for 2013.  But first of all, review these best practices for physician queries.

Queries should be:

• Clearly and concisely written, contain precise language, present the facts and why clarification is needed, present the scenario
• Individualized to each patient and contain clinical evidence specific to the case
• Non-leading
• Used to clarify the intent of the physician
• Include the option that no additional documentation or clarification can be provided
• Addressed to a specific provider and close with the query author’s name and phone number
• Maintained in the medical record and be used as supporting documentation for coding
• Sent using only approved templates

On the other hand, queries should not:

• Result in a yes/no answer
• Be used as  a substitute for appropriate physician documentation in the record
• Indicate to the provider an increase/decrease  in payment
• Introduce information not otherwise contained in the medical record

Facilities should have a clear written policy or procedure to address the entire query process. The policy should:

• Explain when it is appropriate to query a physician
• How the query should be conducted
• Address where and how long the query will be kept

Make sure staff members are trained so they are familiar with acceptable query procedure.

Audit completed queries. Queries should be properly completed and appropriately dated and authenticated or they are noncompliant.

Organizations must also develop processes to:

• Notify the provider when a query is placed (email, note, fax)
• Following up on open queries

Next week I will blog about the ICD-10 documentation opportunities that we can begin implementing in 2013.