CDIP Physician Query Process 2 — Questions and Answers
Question 1: Which of the following is an example of a NON-compliant physician query?
- Asking whether a condition meets the definition of sepsis
- Listing only one diagnosis option with no alternative (Correct answer)
- Presenting clinical indicators and asking for clarification
- Providing multiple clinically supported options for the physician to choose
Correct answer: Listing only one diagnosis option with no alternative
A query that lists only one diagnosis without alternatives is considered leading and therefore non-compliant.
Question 2: What is the primary purpose of a concurrent physician query?
- To finalize the DRG after discharge
- To clarify documentation while the patient is still admitted (Correct answer)
- To correct a previously submitted claim
- To obtain a second opinion on the diagnosis
Correct answer: To clarify documentation while the patient is still admitted
Concurrent queries are issued during the patient's stay to clarify documentation in real time, improving accuracy before discharge.
Question 3: When a physician does not respond to a query, the CDI specialist should:
- Code the condition as if the physician agreed
- Escalate per facility policy and follow up appropriately (Correct answer)
- Automatically assign the highest-acuity diagnosis
- Submit the claim without that diagnosis
Correct answer: Escalate per facility policy and follow up appropriately
Non-response should be handled according to facility-specific escalation policies rather than by assuming a response.
Question 4: Which document type is generally considered the most appropriate medium for a compliant physician query?
- Verbal-only communication with no written follow-up
- Handwritten sticky note on the chart
- Standardized written or electronic query form (Correct answer)
- Text message to the physician's personal phone
Correct answer: Standardized written or electronic query form
Standardized written or electronic query forms provide a consistent, auditable, and compliant method for physician communication.
Question 5: A physician query requesting clarification on 'acute blood loss anemia' should be initiated when:
- Any blood transfusion is administered
- Clinical indicators such as low hemoglobin and transfusion are present but the condition is not documented (Correct answer)
- The patient's hemoglobin is within normal limits
- A surgeon requests the query
Correct answer: Clinical indicators such as low hemoglobin and transfusion are present but the condition is not documented
Queries are appropriate when clinical evidence supports a condition that the physician has not explicitly documented.
Question 6: Which of the following best describes a 'multiple-choice' style physician query?
- A query with only one diagnosis listed as an option
- A query presenting several clinically supported diagnoses plus 'other' and 'unable to determine' (Correct answer)
- A query asking the physician to write a new note
- A query that requires the physician to sign a form
Correct answer: A query presenting several clinically supported diagnoses plus 'other' and 'unable to determine'
Multiple-choice queries present several plausible diagnoses supported by clinical evidence, including options for 'other' and 'unable to determine' to avoid leading the physician.
Question 7: Post-discharge queries are typically appropriate in which scenario?
- Whenever the CDI specialist wants to improve the DRG after billing
- When clinical indicators present during the stay were not addressed and the documentation is unclear (Correct answer)
- Only when the payer requests a query
- When the attending physician is unavailable during the stay
Correct answer: When clinical indicators present during the stay were not addressed and the documentation is unclear
Post-discharge queries are justified when clinical evidence existed during the stay but documentation was not clarified before discharge.
CDIP Physician Query Process 2
Which of the following is an example of a NON-compliant physician query?