the query question.” Does this mean the use of “possible”
should never be included as an option in a multiple choice
Answer: This statement in the Practice Brief is referring to the question portion of the query. The bullet point
preceding this statement advises readers to “avoid using
terms that indicate an uncertain diagnosis as defined by
the ICD-10-CM Official Guidelines for Coding and Reporting and Coding Clinic (e.g., “likely,” “probable,” etc.)
as a query response choice unless the query is either provided at the time of discharge or after discharge.” Therefore, the qualifier “possible” should be avoided in both the
question and the response options as it is too broad of a
11. Question: When there is only one clinically supported
diagnosis (such as hyponatremia, hyperkalemia, etc.) option to use in a multiple choice query, is there another reasonable option that can be used?
Answer: All queries should include all clinically reasonable options. If there is only one viable diagnosis, then
options of “clinically undetermined” and “other” should
be added to the options. “Clinically insignificant” or “
integral” may be included when applicable.
12. Question: Why do verbal queries have to comply with the
same rules as written queries?
Answer: A query, whether written or verbal, must follow
the same rules and compliance practices.
13. Question: How many clinical indicators must be included
in the query?
Answer: Queries should include all indicators that are
clinically significant to the condition being queried. The
query author should be familiar with the clinical guide-
lines supported by medical literature and/or organiza-
14. Question: Must “clinically undetermined” be used as a
choice in a query or would “other” suffice?
Answer: “Clinically undetermined,” or other similar
phrasing, should be included in addition to “other” in
multiple choice queries. There are times when the provider cannot make a clinical determination from the current
15. Question: Is it acceptable to ask more than one question
in a query?
Answer: This is up to the discretion of the query author.
It is acceptable to ask two questions in one query as long
as they are related (e.g., when asking for the acuity and
type of CHF), clearly state the relevant clinical indicators,
and follow a compliant process.
16. Question: How can clinical documentation improvement
professionals avoid denials based on lack of “viable alternate diagnoses” in a query?
Answer: Although denials are at the discretion of the
payer, it may be beneficial to confirm that the payer is
familiar with the topics discussed in the “Guidelines for
Achieving a Compliant Query Practice” Brief and understands that the purpose of the Practice Brief is to establish
and support industry-wide best practices for the function
of clinical documentation querying. The Brief is intended
to provide a resource for external reviewers (e.g., the Office of Inspector General, government contractors, payer
review agencies, etc.) in their evaluation of provider queries and the documentation they provide. As discussed in
the Brief, all queries should include all clinically reasonable options. If there is only one viable diagnosis, then refer to Question 11 in this FAQ document. ¢