Q&A: Querying in a time of crisis

Q: We are trying to reduce the number of queries to providers at our hospital because we know they are overwhelmed. The CDI staff is only sending queries if there is a change in DRG, SOI/ROM, or if the diagnosis is listed in the 2020 ACDIS Pocket Guide comorbidity list. While keeping patients and staff safe is still the number one goal, there is interim leniency of quality measures. How much should CDI be querying? How will our queries count in all of this?

A: This is going to vary depending upon how hard you are being hit. Some hospitals are in crisis mode and 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 utilizing CDI professionals to assist with DNFB (discharge not final billed), retroactive queries 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 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. I would suggest working with your CMO to create a plan.

During the intensity of the crisis, you are correct your queries are not the focus but they will be. Once we get through this crisis the work of CDI professionals is going to be even more valuable to our organizations.

Our work is also important to capture accurate data to prepare for the next time this happens.

Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, 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.