ACDIS has released an official stance on the outpatient CDI query process. Their position paper called, “Queries in outpatient CDI: Developing a compliant, effective process” addresses the significant differences between inpatient CDI and outpatient CDI.   This position paper has been built from the foundation of the jointly published AHIMA/ACDIS paper, “Guidelines for Achieving a Compliant Query Practice” which was originally written in 2013, and updated in 2016.  

Outpatient CDI can be performed and beneficial for a variety of levels of care such as the emergency department, observation, diagnostic interventions and physician office encounters.  Outpatient CDI efforts can impact medical necessity of care provided, risk adjustment scores and reimbursement, overall quality of data, and professional billing compliance.

A CDI in the outpatient setting is fast paced due to shorter encounter times and the large volumes of records to review. Retrospective queries are burdensome to providers in an already busy outpatient settings. Therefore, reviews are often done prospectively, or prior to an encounter which allow a provider to respond to the query at the time the patient is seen.

As with the inpatient query process, open-ended, multiple choice and yes/no queries formatting are acceptable in the outpatient setting. There are still various rules and guidelines as in the IP CDI/Query side that are still relevant.  Proper ways to perform a yes/no query are important (and highlighted in this Position Paper, as are the importance of potential POA(Present on Admission)indicators on patients potentially to be admitted to inpatient status.   

The tracking of queries, both verbal and written, is also necessary in the outpatient setting. In addition an escalation process to address unanswered queries should also be developed.  Retention policies and overall CDI and query policies are of importance in a compliance query/CDI program. 

This Position Paper is well done, and should be reviewed and adopted as best practices. 

Please refer to the entire ACDIS article for additional information:

https://acdis.org/system/files/resources/40352_Queries_in_outpatient_CDI_Developing_acompliant_effective_process.pdf


By Barb Brant, MPA RN CDIP CCDS CCS