Q&A: COVID query efforts

Q: We are trying to reduce the number of queries to providers because we know they are overwhelmed with trying to handle COVID-19. We are only sending queries if there is a change in DRG, SOI/ROM, or if the diagnosis is listed on 2020 Pocket Guide comorbidity list. I would like a second opinion on this though. How much should CDI being querying? How will our queries count in all this? I am especially concerned about accurately reporting of ICD-10 codes during this time. I imagine that ICD-10 data will be used to analyze government funds.

A: We’ve heard about reductions in census ahead of the COVID-19 curve and we’ve heard of programs focusing their query efforts to ensure they are targeted and absolutely necessary as mentioned by a couple of the panelists on a recent ACDIS Podcast call (Podcast recap: Adapting to remote work during the COVID-19 pandemic). This is going to vary depending on how hard your area is being hit by the outbreak. Some hospitals are in crisis mode. For these, I would suggest suspending queries except where it is absolutely needed. If your hospital is presently low census as many are (cancellation of electives, etc.), I would focus efforts on reviewing as many records as possible and query as you would normally do.

Those hospitals who are not experiencing the full extent of the crisis are using CDI professionals to assist with the discharged not final billed (DNFB) list, retroactive queries, and physician follow up. They are basically trying to shorten the billing cycle and get their house in order.

If you are presently seeing COVID-19 patients these records should be reviewed to ensure accurate capture of the diagnosis as it is my understanding additional funding will be applied for this population. Some organizations are doing retrospective and post-bill reviews of these records, too.

I would suggest working with your chief medical officer, as well, to create a plan if you haven’t already and also suggest getting education out to your providers about what is needed within the documentation, so that when they see these patient’s they can work to capture it from the start.

There is no right answer to this question. But it is an important one to ask and consider.

Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, CDI education director at HCPro in Middleton, Massachusetts, answered this question. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps, click here.