How ICD-10 Affects Querying and CDI Specialists

CDI for ICD-10I’m frequently asked if I think ICD-10 will cause Clinical Documentation Improvement (CDI) Specialists to take on larger and more querying role.  In my opinion, yes.

I understand that queries from CDI Specialists don’t always tie to reimbursement. However, once claims experience is collected by Payers, I believe a strong tie between all queries and reimbursement will become apparent.

If you’re new to queries, here’s a basic overview:

Physician queries are communications between coding professionals and physicians. The goal of a query is to clarify – or increase specificity – of clinical documentation in support of better care, improved transitions of care, and/or code assignment for billing. Queries most frequently occur in the inpatient setting; however, they can also occur in the outpatient and ambulatory settings.

From an Inpatient perspective, there are two (2) types of queries:

  • Concurrent Queries – These are preferred because they are posed while the patient is still “in-house” and often times at the point of care where the physician is readily available to provide clarification.
  • Retrospective Queries – These often get the most attention. They are generated after the patient is discharged and most typically prevent billing (though, these queries can happen post-billing too). Retrospective queries most commonly come from Coding Staff rather than CDI Specialists.

The reason I believe the CDI Specialists will take on a larger query role with ICD-10 is because of the increased anatomy, physiology, technical, and clinical knowledge required to assign codes with greater specificity – especially with procedure codes. Procedures can impact the MS-DRG assigned and subsequently increase/decrease the payment weight. There is no “unspecified out” with procedure coding because all seven characters must be assigned to qualify as a complete code. If questions surface about a procedure, CDI Specialists are likely to have the most immediate clinical knowledge to pose the inquiry. That’s not to say your Coding Staff won’t rise to the occasion; it is acknowledgement that they may not be geared for the challenge out-of-the-gate.

Additionally, it stands to reason that added details in ICD-10 will result in increased opportunities for queries to be posed. This is something CDI Specialists are likely preparing for without regard to the Coding Staff.

Every organization has unique and different skillsets. The best way to prepare for ICD-10 is to know where your strengths and weaknesses lie. Best of luck with your transition!

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