Most Common CDI and Coding Queries: What Are Yours?

By Brian Murphy

What are your most common CDI or coding queries these days?

There are always a few at or near the top (you probably know the culprits), but I was interested to see if there were any shifts based on the continued growth of Medicare Advantage/HCCs, social determinants of health, changes in provider terminology, pro-active denial prevention/auditor targets, etc.

A quick spin through one of the Facebook groups I frequent turned up several suggestions, which I then added to after posted the question to my network on LinkedIn. This turned up several more via comments.

Here is the complete list in no particular order, other than alphabetical:

• Acute blood loss anemia
• Acute COVID infection confirmation
• Acute respiratory failure validation
• Acute stroke documented in an IP setting with documentation of deficits, without stroke/deficit cause/effect documentation
• Acute stroke documented in an OP setting without coding residual effects
• AKI validation
• Altered mental status
• ATN
• Cachexia etiology
• Catheter-associated urinary tract infection
• Cause/effect (i.e., foley/UTI, Eliquis/GI bleed, etc.)
• Cellulitis/diabetes link
• Cerebral edema and brain compression
• CHF specificity/acuity
• Clinical validation (in general)
• Colitis etiology
• Coma
• Complications of surgery
• Diabetes mellitus with hyperglycemia
• Elevated troponins
• Encephalopathy
• Functional quadriplegia
• Hypo/hypernatremia
• Ischemic bowel
• Malnutrition
• Medication without a specified diagnosis
• Necrotizing fasciitis
• Obesity
• Pancytopenia (drug or chemo induced, in leukemia, etc.)
• Pathology findings (confirmation)
• Pediatric Diagnoses: Hypoglycemia and severity of hypoxic ischemic encephalopathy
• Pneumonia type
• Post-op respiratory failure
• Present on admission confirmation
• Pressure ulcers
• Renal failure
• Rule in/rule out for diagnoses documented as possible
• Sepsis with organ dysfunction
• Sepsis validation
• Shock
• Type II myocardial infarction
• Underweight
• Wounds

A couple great comments included the following:

Not quite what you asked, but I’m curious how SEP-1 now being a value-based purchasing measure will impact the world of sepsis and subsequently our queries. I wonder if providers will be more hesitant to diagnose it in order to avoid the measure. I wonder if hospitals will choose to align their sepsis criteria with the criteria in the measure, and therefore our validation queries will become based on that. And I also wonder if there are opportunities to help these patients land in this bucket appropriately or take them out of it if appropriate, that we may be able to achieve through queries.

Non-pressure skin ulcers! These require SO much information: Site/location, depth, with/without necrosis, laterality, underlying etiology (vascular, diabetic, neuropathic… often the source of intervention but documented poorly).

What do you think of the above list? Any interesting recent examples from your chart reviews? Do you see anything glaringly missing from the list above? Hopefully this sparks some ideas as you are performing your next chart review.

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