Physician Query Process Flashcards
7 cards from real CDIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Physician Query Process flashcards as text
A CDI specialist notices that a patient was treated for heart failure but the physician documented only 'dyspnea.' What is the most appropriate action?
Answer: Send a query presenting heart failure and other clinically supported options for physician clarification
When clinical indicators suggest a specific condition not documented by the physician, a compliant query presenting supported options is the correct step.
Which of the following best describes the 'agree/disagree' query format?
Answer: A query where the CDI specialist states a diagnosis and asks if the physician agrees or disagrees
The agree/disagree format presents one diagnosis and asks the physician to confirm or deny it, and is generally considered acceptable when strong clinical support exists.
Which professional organization, along with AHIMA, co-authored the 'Guidelines for Achieving a Compliant Query Practice'?
Answer: ACDIS
AHIMA and ACDIS jointly published the industry-standard guidelines that define compliant physician query practices.
When a query results in a diagnosis that changes the DRG to a higher-weighted group, this is referred to as:
Answer: A DRG shift or upgrade that is compliant when clinically supported
A DRG shift to a higher-weighted group is appropriate and compliant when the new diagnosis is fully supported by clinical documentation.
Which of the following is a key metric used to evaluate the effectiveness of a CDI program's query process?
Answer: Physician query agreement rate
Physician query agreement rate measures how often physicians confirm the queried diagnosis, reflecting both query quality and CDI-physician alignment.
A query for 'protein-calorie malnutrition' is most appropriately triggered by which combination of clinical indicators?
Answer: Low albumin, unintentional weight loss, and poor nutritional intake documented in dietitian notes
Hypoalbuminemia, unintentional weight loss, and poor intake documented by a dietitian together constitute strong clinical support for a malnutrition query.
Which of the following statements is TRUE regarding verbal physician queries?
Answer: Verbal queries are acceptable only if followed by written documentation per facility policy
Verbal queries may be used but must be followed by written documentation to ensure a complete and auditable record per AHIMA/ACDIS guidelines.