Recording: Webinar: Optimizing Your eQuery Coding Questions
Transcript for Webinar on Optimizing Your eQuery Coding Questions
Slide 1: Introduction
Hello everyone. We are glad that you can join us today for this In the Spotlight webinar.
Slide 2: Agenda
Today’s webinar will cover the eQuery coding question service. We will talk about what you need to know; we will review the criteria for submitting a coding question, which will help optimize your coding question experience — so that you will know what you have to do to submit an optimal coding question; we will then go through some examples of coding questions to see whether they meet the criteria or how we can enhance them to meet the criteria.
There are 2 resources available to accompany this webinar: the bulletin Changes to the Classifications eQuery Coding Question Service: What You Need to Know; and the job aid Resolving a Coding Challenge. You can access them on our website: www.cihi.ca. Once you get there, go to the Codes and Classifications web page, and follow the link to the Classifications resource page, where you will find additional resources available for you.
Slide 3: Criteria for submission
As you likely know, CIHI’s Classifications and Terminologies team adopted criteria for submitting a coding question. These criteria formally came into effect October 1, 2018. Since then, only those questions that meet 1 or more of the criteria will be answered. As part of this process, we developed a job aid to assist. This job aid, Resolving a Coding Challenge, which is one of the resources available on the Codes and Classifications web page, outlines the steps to take to resolve a coding challenge, and it includes the steps you need to take before submitting a coding question.
Slide 4: What does this mean?
So, what does all this mean?
Your question must meet 1 or more of the following criteria:
- You are trying to assign an ICD-10-CA or CCI code for a diagnosis or an intervention but there appears to be no appropriate code available in the classification;
- You are bringing to our attention a possible error you have identified in one of our products such as the classifications (ICD-10-CA and CCI), the Canadian Coding Standards, or identifying a potential gap or a perceived gap in in one of our products;
- You may have identified a potential data quality issue.
- Or perhaps you identified an issue of significant public interest or a strategic policy, such as MAID or opioid poisonings or COVID-19, which we know are of significant public interest.
Slide 5: Coding questions that do not meet the criteria
So what happens when your questions do not meet criteria?
- Hypothetical or general questions — there should be a real case you are trying to code that you need assistance with
- Questions without a copy of the pertinent, de-identified clinical documentation attached — it is always important to see this, as the details of the case often affect code assignment one way or the other
- Questions that are asking our team to validate the code assignment without a specific issue identified
- Questions for which the answers are found in the available resources, such as coding standards or a Tip for Coders
- Questions that are asking the Classifications and Terminologies team to look at documentation deficiencies (illegible documentation)
- Or something that is out of the Classifications and Terminologies team’s realm of expertise. For example, a question that is about data abstracting elements or fields or about Resource Intensity Weights (RIWs) or case-mix grouping. You can submit these questions via the eQuery tool, but they are submitted to a different program area at CIHI. Questions about abstracting, data elements or fields are submitted to the Clinical Administrative Databases or CAD team, also known as the Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS) team. Questions about the grouping methodology are submitted to the Case Mix team. Additionally, questions of a clinical nature which are beyond our scope of practice should be addressed with the responsible health care provider.
Slide 6: When do you submit a question?
So, what happens? When do you submit a question? There are specific criteria and steps to follow before hitting the submit button. When do you know for sure you need to submit a question? As detailed in the job aid, you are first going to try to resolve the challenge using all available resources. If you cannot do so or if your question meets the criteria, then you know that it is time to submit the coding question.
Slide 7: How do you formulate a question that meets the submission criteria?
Once you are ready to formulate your question, you need to be sure to include certain elements to optimize your coding experience. If you are following along, this takes us to step 3 of the job aid and includes the following important elements:
- Clearly articulate the challenge or question you are trying to answer.
- List all the pertinent facts and details from the source documents and clinical documentation.
- Identify the specific resources you used (for example, coding standard directive statements) and how you applied them to this case.
- Provide the specific ICD-10-CA and CCI codes and the code title, as applicable, for the options you considered.
- And always attach de-identified pertinent clinical documentation.
When the submission criteria are met and these important elements are included, it helps us to clearly understand your challenge. We have a better understanding of your thought processes, how you applied the available resources — and that enables us to identify potential gaps or know where further clarification is required in one of our products. The details also help us to provide you with clear, appropriate and complete direction.
Slide 8: Optimizing your eQuery coding questions
To optimize your coding question experience, you must identify the specific challenge. Include the pertinent facts, details, and the resources you used. Be as clear as possible and include any thought processes and issues you have. List the ICD-10-CA and CCI codes and code titles you believe are possible options, and attach a copy of the de-identified, pertinent clinical documentation. Once you complete all these steps, then you submit your coding question.
We will now pause for a poll question.
Slides 9 and 10: Polling question
The first poll question is, since the criteria for submission was formally implemented, we have seen a decrease in the number of questions being submitted. Based on your experience, which of the following may be the reason for this decrease?
- I am making better use of available CIHI resources (e.g., iCODE, education)
- I find the process too confusing and/or too time consuming
- I stopped submitting questions because I am concerned my question won’t be answered
- No change in the number of questions I submit
I will leave the poll questions open for a couple of seconds to give you an opportunity to answer. I will then close the poll question and share the results.
31% of you find the process too confusing and/or time consuming, followed by 27% those who have stopped submitting questions because you are concerned your question won’t be answered.
Those are interesting results.
The other 2 options are close behind: 25% for no change in the number of questions submitted and you are making better use of available CIHI resources — 17%.
We’ll now continue the presentation.
Slide 11: Coding question examples
We will now look at examples of coding questions. As we do this, we will ask, using poll questions, whether you feel the questions meet the criteria for submission. We will then look at ways we can improve them when they don’t.
- Using a poll question, we will ask “does this meet the criteria for submission?” You will answer “yes” or “no.”
- While you are considering your answer, think about what criteria have or have not been met to justify your answer. We recommend you have access to the job aid, look it over, have a look at the poll question, and see what criteria have or have not been met.
- Following the poll question, we will go over each question and explain why it does or it does not meet the criteria for submission.
Slide 12: Coding question example 1
The first question: Does this question meet the criteria for submission?
The question that we received was:
We coded the chart as follows: J03.9 as the most responsible diagnosis, acute tonsillitis, unspecified, with J35.0 as the diagnosis type (3). Have we assigned the correct code as the MRDx for this case?
Does this question meet the criteria for submission? I will open the poll question and give you an opportunity to answer whether you feel that it meets the criteria for submission, and I will give you a few seconds to answer. I will then share the results.
98% of you answered that you did not feel that it met the criteria for submission. So, I will now go back and share with you why it does not meet the criteria for submission.
Slide 13: Coding question example 1
The question did not meet the criteria for submission because it did not identify a specific coding challenge. It was asking for validation of code assignment. It did not include any facts or details. And a copy of the de-identified pertinent clinical documentation was not provided. We were unable to determine why the coder was questioning how the case was classified.
We’ll now look at a question that does meet the criteria for submission.
Slide 14: Coding question example 1
This is the same question but with much more information.
This patient was admitted for a tonsillectomy for chronic tonsillitis. The physician documented the final diagnosis as “acute and chronic tonsillitis.” The coding standard Acute and Chronic Conditions directs to assign a code for the acute condition and that a code for the chronic condition is assigned optionally. The coding standard Diagnoses of Equal Importance directs to assign a code for the condition for which a definitive surgical procedure was performed, and so does the direction in the answer to coding question #12345. The code assignment options we considered are J03.9 Acute tonsillitis, unspecified as the most responsible diagnosis, to denote the acute condition, or J35.0 Chronic tonsillitis, because a definitive surgical procedure was performed and per the direction in the answer to coding question #12345. I sent a copy of the operative report. Which direction applies to this case?
This question now meets the criteria:
- It identifies the specific coding challenge that you are facing — how to code acute and chronic tonsillitis in this specific circumstance.
- It identifies the resources that were used — the specific coding standards reviewed and an answer to a previous coding question was referenced.
- It also identifies the possible ICD-10-CA code options that were considered and the rationale for choosing these options.
- In this circumstance, we can see that clinical documentation, which is the operative report, was provided.
All these pieces of the puzzle really help to make this coding question optimal and will make your experience optimal as well.
We are going to look at an additional question now.
Slide 15: Coding question example 2
This is another example of a coding question we received.
This is a general question. I do not have a specific case to send. How do you code a manual reduction of a scrotal mass?
Does this question meet the criteria for submission? We’ll pause for the third poll question now. Again, does this question meet the criteria for submission? I will wait a few seconds, close the poll question and then share the results with you.
All of you answered this question did not meet the criteria for submission.
Back to the presentation and I will share with you why it does not meet the criteria for submission.
Slide 16: Coding question example 2
This question does not meet the criteria for submission because
- It was a general or hypothetical question
- It did not identify a specific challenge — why was the client asking how reduction of a scrotal mass is coded?
- It did not provide any facts or details about the case
- A copy of the de-identified pertinent clinical documentation was not provided from which we could help direct them to a correct code
Slide 17: Coding question example 2
Here is the same general question that includes more information.
The final diagnosis is documented as scrotal mass not yet diagnosed (NYD). The physician attempted to manually reduce the mass. How do we code the reduction? See the attached documentation.
The CCI alphabetical index leads to Reduction, scrotum for elephantiasis 1.QG.78.^^. Generic intervention (73) reduction is not an option for anatomy group (QG) scrotum. Open approach is the only option available at rubric 1.QG.78.^^. This was not the approach used for this case. Is 1.QG.78.LA Repair by decreasing size, scrotum, using open approach the correct code?
This question now meets the criteria:
- It identifies the specific coding challenge — a manual approach is not available as an option at the applicable rubric, which indicates a possible gap in CCI.
- It identifies the CCI alphabetical index look-up, as well as the specific CCI code and code title that is being considered.
- And a copy of the de-identified clinical documentation was provided with this coding question.
We’ll now move on to the next example and poll question.
Slide 18: Coding question example 3
This is the third example and the final poll question. Again, the question is, does this question meet the criteria for submission?
How would you code a buckle fracture of distal radius? There is no documentation available.
I’ll open the poll question. Does this question meet the criteria for submission? Yes or no?
I will wait for a few seconds and then I will close it and share the results.
All agree that it does not meet the criteria for submission. I will now go back to the presentation and share with you why it doesn’t meet the criteria for submission.
Slide 19: Coding question example 3
The question does not meet the criteria for submission because
- It is a general or hypothetical question
- It did not identify a specific challenge
- It did not provide any facts or details about the case
- It did not provide a copy of the de-identified pertinent clinical documentation
We’ll now look at an optimized question.
Slide 20: Coding question example 3
Here is the same general type of question with a bit more detail.
How is a buckle fracture of the distal radial metaphysis classified? We sent a copy of the emergency record. We asked an orthopedic surgeon and she told us a buckle fracture is an incomplete fracture because the break is only on 1 side of the bone. It is also known as a torus fracture. There is no alphabetical index entry for “buckle,” “torus” or “incomplete” fracture of the distal radius. Therefore, we feel this should be classified to S52.580 Other fracture of lower end of radius, closed. Is this correct?
This question now meets the criteria:
- It identifies the specific coding challenge, which is how is a buckle fracture of the distal radial metaphysis classified?
- It identifies the rationale behind the code choice as well.
- It identifies the resources used and includes that an orthopedic surgeon was consulted.
- As well, a copy of the clinical documentation was provided.
- And the question identifies the possible ICD-10-CA alphabetical index look-up, and the specific code and code title that is chosen.
Slide 21: Resources: Bulletin and job aid
That’s it for our examples. We provided you with some examples. We will now provide you with some resources to help you make your question better and will help optimize your coding question experience. We hope you find them useful.
The information about the eQuery coding question service is found in the bulletin that was released April 10, 2018. An updated version of the bulletin was released April 1, 2022. Information about resolving a coding challenge is found in the job aid. Both resources are available on the Codes and Classifications web page, and there is a link on the screen that you can use.
Slide 22: Resources
These are not the only resources. There are several other resources that are available to you:
- First, the classifications (ICD-10-CA and CCI) include built-in coding rules, conventions and instructional notes that help guide you to the correct code.
- The Canadian Coding Standards supplement the classifications by providing additional information that cannot be embedded directly into the classifications. Each coding standard includes a directive statement and several examples to demonstrate how to apply the directive statement. When you are looking at a coding standard, be sure to read the coding standard in its entirety, because many times one of those examples are very similar to a case you are trying to classify.
- We also have lots of education products, and we have a guide that will help direct you to the product you need. The Education Roadmap: Reach Your GOAL With Classifications, the DAD, NACRS and Case Mix is also available on our website and provides a list of education products and when during your career path it is best to complete them.
- The A Guide to Obstetrical Coding and the CCI: A Guide to Intervention Code Assignment were formerly education products. They are now available on our web page as guides.
- Tips for Coders are definitely a good resource. Bulletins, as well, provide direction and potential clarification on topics that appear to be a challenge to you or are identified as a data quality issue.
- eQuery, our coding question service, of course, which we are talking about today, is a repository of previously asked and answered questions. Always check to see if your case is like a question that has already been asked and answered.
- The iCODE strategy was developed by CIHI’s Classifications and Terminologies team specifically for coders. It is meant to help them work through a challenging case. If you are not familiar with the iCODE strategy, there is a Practice With iCODE case series available on CIHI’s eLearning centre. These cases will provide you with the opportunity to apply the iCODE strategy by working through some challenging cases.
- Of course, there is always Google! Credible websites, reference materials are also a good resource.
- Finally, a great resource is other experienced health information management professionals. You can talk through your coding challenges with them. We encourage you to take advantage of their knowledge, expertise and experience. They are working beside you and are most likely the people who really understand your challenges.
Slide 23: Questions?
We’ll now address some questions that were asked during the presentation.
The initial poll question identified that a lot of people find the process too confusing or difficult. Therefore, we developed the job aid. Follow the job aid and make sure that you include as much information as you can. Identify the problem or challenge you are having with classifying the case. You always must attach a copy of the de-identified, pertinent clinical documentation. This is nothing new. It certainly makes a difference when you look at the documentation for an actual case. Take your time and go through the job aid. If you do send a question and we say that we cannot answer it, we will let you know the reason and we will invite you to re-submit your question. There is a quick turnaround time for that. Usually, we will get back to you within a day or so to let you know that your question does not meet the criteria. You will see what we said is missing. You will be able to add the missing information and re-submit the question. We encourage you to do that.
- What do we do if we do not have access to the documentation?
That is something that neither the classifications nor the coding standards can address. We cannot address deficiencies in documentation. If you do not have access to the clinical documentation that you need to classify a case, we are not able to help you either. We really rely on the clinical documentation to give us the information we need to determine which code is best to describe the diagnosis or intervention for that case. - What is the expected turnaround time for answering a question?
The current turnaround time is 12 days. When you submit a question you should get a system-automated response that advises you that you will get an answer within 12 business days. - What if you cannot find a code in the classification (because it doesn’t exist) and the question is about finding the correct code, does this meet the criteria?
Provide as much information as possible about that episode of care, a copy of the de-identified pertinent clinical documentation and which code you feel would best represent that case and we will provide you with the appropriate direction.
It is not that you must provide the exact code that you are considering. You can provide a couple of options and say, “I’m not sure if it’s this one because of this inclusion note” or “I’m not sure if it’s that one because the documentation is referring to such and such.” Just give us an idea of your thought process. That is really the key. We want to know your thought process — what is it that is causing you to question how this case is classified or what is it that is causing you to have difficulty with classifying this case? What is the challenge you are having? Spell it out for us, to help us help you. Your question may help us identify if this is something we may need to add to the classifications or the coding standards, or for which we may have to develop a Tip for Coders or education. We rely on you to help us enhance our products. - Is there a checklist or template we can use when formulating a coding question?
That is one purpose of the job aid. It is a checklist of everything that you should do or that you should include in your question.
The job aid is a checklist you can use. However, we will take your idea back to the team for consideration for development of a template. It is something we can consider.
You must first identify the specific coding challenge. Include the pertinent facts and details. List the ICD-10-CA and/or CCI codes and code titles and attach a copy of the de-identified, clinical documentation for the specific case and submit the question.
Many of you are already doing all of this. So, thank you! We have some good coding questions that have been submitted and we appreciate that your time is limited. You are doing the best you can. If you can give us as much information as you can and do the best you can with your coding question, we do our best to help you.
Thank you so much everybody for joining us today. It was a pleasure to present this material to you today. I hope you are walking away from this presentation with some ideas and thoughts on how to optimize your coding questions to get the answers you need.
Slide 24: Contact us
Send any questions you have about eQuery to classifications@cihi.ca.