By Lisa A. Eramo
Any ICD-10-CM/PCS to-do list wouldn’t be complete without the task of reviewing and revising query templates. Industry experts say all providers should take a close look at their query forms and make adjustments, as necessary, to reflect the added specificity in ICD-10-CM/PCS.
Don’t assume that current queries can stand the test of time once ICD-10-CM/PCS goes into effect, says Cheryl Robbins, RHIT, CCS, director of remote coding operations for Precyse in Dallas, Texas. “There is an inherent risk in doing nothing simply because of the level of detailed required in ICD-10,” she says.
The sooner providers can start the query revision process, the better. In its ICD-10-CM/PCS transition planning and preparation checklist—which includes an implementation timeline—AHIMA states that hospitals should already be assessing documentation quality and taking steps to improve it. This monitoring and improvement should continue throughout—and even after—the implementation.
“Start the metamorphosis of your query forms now so physicians can adjust and get used to the level of detail,” says Robbins.
Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, HIM professional in Fremont, Calif., agrees. “The idea with queries is that physicians improve their documentation over time and that the query serves an educational purpose as well,” she says.
Coders can—and should—play a role in identifying queries and helping to revise query language, says Sandra L. Macica, M.S., RHIA, CCS, coding content manager at Elsevier in Atlanta. “Coders are in the records every minute of every day. They know which providers document concisely and which do not,” she says. “They can help by looking at the current documentation and determining if what is needed for future coding is present currently.”
Take a step-by-step approach
Consider these steps when approaching the oftentimes daunting task of revising queries:
Step one: Inventory all queries.“You may find that some [queries] are no longer relevant, or some are so poorly written that you wouldn’t want to be using them in the first place,” says Robbins.
Also run a report of most frequently asked queries, says Bryant. “How many queries did you send to physicians, and what queries were they?” This will help providers understand the breadth of queries they must update as well as any queries on which they may want to focus, she adds.
Step two: Compare documentation requirements. Compare the language in ICD-10-CM/PCS with that of ICD-9-CM. Diagnoses that are problematic today will likely continue to be problematic in ICD-10-CM, says Robbins. Other diagnoses will simply require more detail. Consider the following: [Note: This is not an all-inclusive list of diagnoses for which query templates must be updated]
- Asthma—Ensure that physicians distinguish between mild intermittent, mild persistent, moderate persistent, and severe persistent.
- Coma—Ensure that physicians document a Glasgow coma scale score.
- Diabetes—Ensure that physicians document the type of cause of the diabetes, specific complications or manifestations, as well as the drug that caused the diabetes (when due to drugs or chemicals). The terms ‘controlled’ and ‘uncontrolled’ are no longer relevant, says Macica.
- Myocardial infarction—Ensure that physicians document the type and site.
- Open fractures—Ensure that physicians document the Gustilo-Anderson fracture classification for certain open fractures (i.e., S52, S72, and S82).
- Pathologic fractures—Ensure that physicians document the exact location of the fracture (site and laterality), the etiology of the fracture, and the encounter type.
- Pregnancy—Ensure that physicians document the specific trimester in which any conditions/complications of pregnancy occur.
- Hematuria—Ensure that physicians document whether the hematuria is gross, benign, or microscopic.
- Angina—Ensure that physicians distinguish between unstable angina and angina pectoris with documented spasm or other form of angina pectoris. Various inclusion terms are new in this code category. “The descriptors are different, so queries may need to change,” says Bryant.
- Hemorrhage and stroke—Ensure that physicians document specific anatomical location and laterality.
Don’t forget ICD-10-PCS
Although most queries today focus on diagnoses, that may change in ICD-10-CM/PCS. Coders may find themselves querying for surgical procedures as well, says Robbins.
“The procedure coding system is all new,” Macica adds. “Facilities need to do the same [review] for procedures that they are doing for diagnoses. What are your top procedures, and is the documentation there to support them under the new system? If not, new queries will need to be developed.”
For example, review a sample of hip and knee replacement cases to determine whether documentation meets ICD-10-PCS requirements, says Bryant. When coding a hip replacement, ICD-10-PCS table 0SR identifies laterality as well as the specific device used (synthetic substitute [metal or ceramic], autologous tissue substitute, or nonautologous tissue substitute). For synthetic substitutes, coders have the option to report cemented or uncemented.
Consider these tips
To ensure clear and compliant queries in ICD-10-CM/PCS, consider the following:
- Use available resources. When revising query templates, refer to the ICD-10-CM/PCS manuals as well as AHIMA’s query practice brief, Guidelines for Achieving a Compliance Query Practice. As Coding Clinic begins to publish ICD-10-related questions and answers, be sure to review this information as well.
- Team up with clinical documentation improvement (CDI) specialists. It may be challenging for coders to translate some of the clinical details of ICD-10-CM/PCS into query templates without leading physicians, says Robbins. “The query will need to be written very clearly and with more clinical detail. If it’s not done well, it could potentially be leading,” she says. Coders should work with CDI specialists and/or a physician champion when revising templates, she adds.
- Take it slowly.“Consider looking at a diagnosis or procedure a week,” says Macica. “As coders are currently assigning codes, they can be on the lookout for problem areas. The challenge is that if that are not very familiar with ICD-10-CM/PCS, they don't know what those problem areas are yet.”
- Plan ahead. Finding the time and resources to devote to this effort may be challenging as well, says Bryant. “Lack of resources is usually the number one issue. Set aside time with your own staff or hire external resources to assist with this effort,” she says. “You don’t want to have massive volumes of queries being generated and sent to physicians on October 1, 2014, and through the first two or three months following go live. You want to be proactive rather than reactive, so use the coming months to get ready.”
Editor's note: Eramo is a freelance writer and editor in Cranston, R.I., who specializes in healthcare regulatory topics, health information management, and medical coding. You may reach her at leramo@hotmail.com.