This page addresses follow-up questions and additional information pertinent to our webinar
Outpatient Coding Queries Compliance: Avoiding Legal and Financial Pitfalls.

** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q:  Do queries have to be multiple choice or are there other formats that are recognized? Are verbal queries acceptable?
A:  Written queries can also be open-ended to allow the provider to add free text responses, but we recommend using either a multiple-choice or yes/no/unknown format since open-ended queries don’t always answer the question we’ve asked. There is more information about that in the Practice Brief. Verbal queries are acceptable, but all conversations should be documented. Conversations should be non-leading and include all appropriate clinical indicators and potential options.

Q:  Coding Clinic, 3rd Quarter 2021 states that conditions cannot be solely coded when they are documented in the past medical history or medication list. How should a condition that is documented in the history of present illness be coded when there is an associated chronic condition that is only documented on the past medical history? For example, a patient presented to the ED for decompensated heart failure and was given oral Lasix. The past medical history also indicates that the patient has hypertension, and the medication list includes lisinopril as a current medication. Can a combination code for hypertension with heart failure be assigned?
A:  When two conditions have an assumed causal relationship and one of the conditions is documented as clinically significant, but the other condition is only documented in the past medical history, problem list, or medication list, the provider should be queried to determine if the latter condition is clinically significant and should be reported. Provider documentation should state the clinical significance of each condition included in a combination code to report it.

Q:  Is there a certain timeframe in which queries should be sent?
A:  Organizations may set guidelines on when queries can be issued based on the timing of the patient encounter, such as before, during, or after discharge. Specific timeframes for queries may be established, with best practices recommending queries be sent as soon as possible after the encounter. If a query is initiated after billing, procedures should be in place to allow for claim adjustments if reimbursement is affected.

Q:  Are coding professionals allowed to send multiple queries?
A:  There are times when multiple queries are necessary. Some examples are when clarification is needed on the same set of clinical indicators, or conflicting documentation is present. A coder should exercise caution when trying to obtain too much information in one query. It is best to address one issue at a time. Also, do not send the same query to multiple providers to derive a desired result.