Q&A: Standardizing a coding query process

Q: Our coding department doesn't have a standard query process. How can coders be sure whether an issue is worth querying?

A: If a medical practice wants to avoid denials, it may need physicians to provide more clinical detail to support the proper ICD-10 codes. This can be done through queries, but too many queries can be overwhelming for the already busy physicians. Therefore, coders should try to follow the following guidelines to help make the decision of whether to query:

• Are there elements or information missing from the medical record?
• Are there conditions or procedures that need more detail to support a specific ICD-10 code?
• Does the medical record contain conflicting information?
• If there is an unspecified diagnosis, is there information that suggests that a more specific diagnosis is possible?

If a coder decides that a query is necessary, AHIMA/ACDIS has formalized guidelines for coders to follow to ensure that the query is written in clear, concise, and precise language; contains evidence specific to the case; is nonleading; is an essential part of the clinical documentation; and includes ICD-10 language.

Editor’s note: This question was adapted from the HCPro book The Complete Guide to Medical Necessity: JustCoding’s Training and Education Toolkit by Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC.

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