Recording: Webinar: Optimizing Your eQuery Coding Questions

Transcript for Webinar on Optimizing Your eQuery Coding Questions

Margaret Penchoff: Without further adieu, it gives me great pleasure to introduce today’s speaker, Denise Cullen. Denise is a Program Lead with CIHI’s Classifications and Terminologies team.
Now over to you Denise . . .

Slide 1: Introduction

Thank you Margaret and hello everyone. We are glad that you are able to 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 will be what to do; we will then go through some examples of coding questions to see whether they meet the criteria or not or how we can enhance them to meet the criteria. At the end, we have some time to answer any questions you may have.

For your convenience, we have added 2 resources to download with this presentation: The bulletin Changes to the Classifications eQuery Coding Question Service: What you Need to Know; and, the Job Aid- Resolving a Coding Challenge. They are both there. You can download them now to have along with the presentation if you like. These are also accessible from our website: www.cihi.ca. Once you get there, manoeuver to the Codes and Classifications webpage where we have many resources available for you there as well. 

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 1st, 2018. Since then, only those questions that meet one or more of the criteria will be answered. As part of this process, we developed a Job Aid to assist you with this. This Job Aid, Resolving a Coding Challenge, which is one of the attachments I just mentioned, outlines the steps to take to resolve your own coding challenges and it includes the steps you need to take before actually submitting a coding question.

Slide 4: What does this mean?

So, what does all this mean?

  • Your question must meet one 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, which we know, are of significant public interest these days.

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 Classification and Terminologies team’s realm of expertise. For example, a question that would be about data abstracting fields or RIW Case mix grouping. These can be submitted using the eQuery tool of course but they go to a different program area at CIHI. Abstracting goes to Clinical administrative databases, or CAD, as we like to call it here or DAD/NACRS. Any grouping methodology questions are meant for Case Mix. Additionally, questions of a clinical nature which are beyond our scope of practice should be addressed with the responsible healthcare provider.

Slide 6: When do you submit a coding question?

So, what happens? When do you submit a question? Well, basically, there are specific criteria and steps to follow before hitting that submit button. When do you know for sure you need to? As detailed in the Job Aid, you are first going to try to resolve the challenges using all available resources. If you cannot do so or your question does meet 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 in order to optimize your coding experience. This takes us to step three of the Job Aid, if you are following along 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 really 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

In summary, to optimize your eQuery – that did not work. Well, there was a lovely diagram here but it does not seem to be showing up. I apologize for that but in general, if you want to optimize your coding question experience, you have to 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 de-identified, pertinent clinical documentation. Once you complete all these steps, then you submit your coding question.

I am going to pass it over to Margaret now who is going to do the first poll question.

Slide 9: Polling question

Thank you, Denise. I am going to open up the first poll question. 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?
So again, answer it from your group’s consensus perspective.

  • 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

So, 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.
31% of you find the process too confusing and/ or time consuming followed by 27% that I stopped submitting questions because I am concerned my question won’t be answered.
So, those are interesting results. The other two options are close behind. 25% for no change in the number of questions submitted and I am making better use of available CIHI resources – 17%.
I will now pass it back over to Denise to continue the presentation.

Slide 11: Coding question examples

So, next what we are going to do is we are going to look at the coding question examples. When we do this, we are going to poll you as well again to determine if they meet the criteria or not for submission and look at how we can improve them if they don’t.

  • We will do this through the poll questions like I said again, where you will answer yes or no to the question: does this meet the criteria for submission?
  • While you are considering your answer, think about what criteria have or have not been met to justify your answer. So, probably pull up that job aid, look at it, have a look at the poll question, and see what criteria have or have not been met.
  • Following the poll, we will go over each question and explain why it does or it does not meet the criteria for submission.

I’ll pass it over to Margaret.

Slide 12: Coding question example #1

So, the first question is, does this question meet the criteria for submission?
The question that we received was, we coded the chart as followed and there is:
J03.9 as the most responsible diagnosis, acute tonsillitis, unspecified with J35 as the diagnosis type 3. The question is have we assigned the correct code as the MRDx for this case?

So, does this question meet the criteria for submission? I will open the poll question and give you an opportunity to answer whether or not you feel that it meets the criteria for submission and I will give you a few seconds. Again, answer the poll question from the group’s consensus perspective.

I will 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

So, the question did not meet the criteria for submission because it did not meet a specific challenge. It was more or less asking for validation of code assignment. It did not provide any facts or details. So, we were not sure why there was question as to how the case was classified.

So, back over to you Denise to share with the participants a question that does meet the criteria for submission.

Slide 14: Coding question example #1

Thanks Margaret. So, here we have the same question more or less but with much more information included and this question meets the criteria because:

  • It identifies the specific coding challenge that you have that you are facing in answering this question and that is how to code acute and chronic tonsillitis in this specific circumstance.
  • It identifies the resources that were used – the specific coding standards reviewed and a previous coding question that they referenced.
  • It also identifies the possible ICD-10-CA code options to consider along with the rationale for them.
  • And in this circumstance, we can see that clinical documentation, which is the operative report here in the last sentence, is provided. And all of these pieces of the puzzle really help to make this coding question optimal and your experience will be optimal then as well.

We are going to look at an additional one now, Margaret.

Slide 15: Coding question example #2

Thank you Denise. So, this is another example of a coding question that we received. This is just a general question. I do not have a specific case to send. How do you code a manual reduction of a scrotal mass?

So, does this question meet the criteria for submission? I am going to open the third poll question now. So again, does that question meet the criteria for submission? And I will wait a few seconds, close the poll and then share the results with you.

So, 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

Okay, so 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 could be coded?
  • It did not provide any facts or details about the case
  • It did not provide a copy of the de-identified pertinent clinical documentation from which we could help direct them to a correct code.

Back to you, Denise.

Slide 17: Coding question example #2

All right, here is the same ‘general question’ that is now improved to meet 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, the specific CCI code and code title that is being considered.
  • And of course, the de-identified clinical documentation was provided here with this coding question as well

So, we’re going to move on with the next example and poll question with Margaret.

Slide 18: Coding question example #3

Okay, so this is the final poll question and the third example. And so, the question again is, does this question meet the criteria for submission?

How would you code a buckle fracture of distal radius?
There is no documentation available.

So, I’ll open the poll question. Does this question meet the criteria for submission? Yes or no?

Now, it looks like we are off to a good start. A lot of people have already started answering the poll question. I will wait for a few seconds and then I will close it and share the results.

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

So, that 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

So back to you now Denise to share with them an optimized question.

Slide 20: Coding question example #3

Absolutely Margaret. Here is the same general type question with a bit more revamp and this one meets the criteria because:

  • 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 really including here that an orthopedic surgeon was consulted.
  • and  clinical documentation was provided here as well
  • And as well, 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

Okay so, moving on. That is it for our examples. We only have a short amount of time. So, we just want to provide you with an example of how you can make your question better. We hope you found it useful.

I’d like to once again let you know there are resources available to help you to optimize your coding question experience.

Of course, the information about the eQuery coding question service is found in the bulletin that was released on April 10th of 2018

Information about resolving a coding challenge is found in the job aid.
And both of these are available on our website again, the Codes and Classifications web page and there is a link there on the screen that you could use for that.

Slide 22: Resources

Of course, these are not all the resources we have. There are many resources that are available for you to use:

  • First of all, the classifications (ICD-10-CA and CCI) include built in coding rules, conventions, and instructional notes that will help to guide you to the right code.
  • The Canadian Coding Standards, of course, they supplement the classifications by providing additional information that cannot be embedded into the classifications. Each standard includes a directive statement and several examples to demonstrate how to apply the directive statement. So when you are looking a coding standard, be sure to check the whole standard, because many times, one of those examples are very similar to one of your cases.
  • We also have lots of education products and we have a guide. If you are looking for a list of education products, you can look at the “Education Roadmap: Reach Your GOAL With Classifications, the DAD, NACRS and Case Mix” also available on our website.
  • Guides such as the “Guide to Obstetrical Coding” and the “CCI: A Guide to Intervention Code Assignment” once were formally education products. They are now available on our web page as well.
  • Tips for Coders, definitely a good thing to look at. Bulletins, as well, provide a direction and potential clarification on topics that appear to be a challenge to you or are identified as a data quality issue. Just a note – the next tip is to be posted very soon. So, keep your eyes open for that one.
  • eQuery, of course, which we are talking about here today, is a repository of previously asked and answered questions. Always check to see if you have a similar case to something that was already asked and answered.
  • The iCODE. The iCODE was developed by Classifications and Terminologies at CIHI and it was developed specifically for coders to help them work through a challenging case. If you are not familiar with the iCODE, there is a ‘Practice with iCODE case series’ available through CIHI e-Learning center. They will provide you with the opportunity to really take this iCODE strategy and apply it to working through some challenging cases.
  • And of course, you can always Google! Credible websites, reference materials as well
  • And finally, one that is probably a great resource for you, other experienced health information management professionals. They are often a great resource. You can talk through your coding challenges with them. We encourage you to really take advantage of their knowledge and experience as well. They are the ones in the weeds there with you and they are the ones that really understand your challenges too.

Slide 23:

So, the recorded webinar, we recorded this one here today, will be available on our web page after March 15th, 2019. So, if you have colleagues who could not attend today, certainly, they could download that after March 15th and hear the presentations themselves.

That is pretty much it. We can now look at some questions. Margaret, do you have any questions right now?

Slide 24: Questions?

So far, Denise, no questions have come in. So, we will just wait a few seconds and see. It doesn’t appear that there is anyone typing any questions in the Q&A pod.

Slide 25: Contact Us

Okay. One thing, I don’t mind like just jumping in, I noticed with the initial poll question that we had, a lot of people found the process too confusing or difficult. So, this is why we developed the job aid. Essentially, just follow that and make sure that you include as much information as you can. Tell us what the problem is. You always have to attach documentation. This is nothing new. We have been saying that for awhile. I mean, it certainly make a difference when you look at the actual case. Just take your time, go through the Job aid. If you do send in a question and we say that we are not responding, we will let you know why we are not responding and we will invite you to re-submit your question. There is a quick turnaround time for that. Usually, within a day we will get back to you and let you know that your question does not meet the criteria. At that point in time, you can just see what we said is missing and then add it and re-submit. Certainly, we encourage you to do that.

Slide 8: Optimizing your eQuery coding questions

There you go. We tried to load up on the screen the slide that did not work for us earlier. You can see it here now. It is a nice diagram. So, we thought you might like to look at it. It just shows you the whole process in a nutshell.

  • Identify the challenge
  • Include all the facts and details and resources
  • List the code and code titles
  • Attach documentation

When all those four things are included, you can hit the submit button and send it to us.

Are there any questions now, Margaret?

Okay, so there is one comment, I guess it is more of a comment from one of the participants that we do not always have documentation available to be more specific. So, that is one of the things that neither the classifications nor the coding standards can address. It is when there is no documentation. We cannot address deficiencies in documentation. So, if you do not have access to documentation that you need to assign codes. Then, we are not able top help you wither. So, we really rely on that documentation to give us additional information to determine which code is the best fit for that case. Anything else, to add Denise, about that?

No, that is perfect. Yup.

Then there is also somebody asking if they can get a copy of the slide deck? That will be available in the recorded version.

Absolutely yes, when the recorded version is posted, the slide deck will be posted as well.

Okay and another question was what is the expected turnaround time for answering a question. Current turnaround time is 12 days. So, you should get a system automated response that you should get a response within 12 business days.

And what if they cannot find a code to submit and the question is about finding the correct code? That is fine.

So, I think you covered t his already, Denise, that, provide as much information as possible about that episode of care and a copy of the pertinent clinical documentation and which code you feel would best represent that case and we can provide you with the appropriate direction.

It is not necessarily that you have to provide the exact code that you are considering.
You could provide maybe two or 3 codes and say, “I’m not sure if it’s this one because of this includes notes, 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 have difficulty with coding this case? What is the challenge you are having? Just kind of spell it out for us to help us so we really know if this is something maybe that we need to put in the coding standards, develop Tips for Coders about it. We rely on you out there to really help us enhance our products.

And I think that is one of the purposes of the Job aid. It is more or less a checklist of everything that you should have done or should be including in your question.

I agree, Margaret. It is like a checklist you can use. We will take your idea and consider it for the development of a template. It is something we can consider. Yes.

And this diagram that is currently on the screen is another more or less checklist of what you need to do before you send a question. You identify the specific coding challenge. Include the pertinent facts and details. List the ICD-10-CA and/or CCI codes and code titles and then attach the documentation and submit the question.

Many of you are already doing all of this. So, thank you. We have some good coding questions that are coming in and we appreciate that your time is limited. You are doing the best you can, sometimes. If you can give us the most information you can, do the best you can with your coding question, then we will strive to help you.

Any more questions Margaret or comments that we need to share?

There was just one more comment that they would have liked to see the eQuery itself. So, we will take that into consideration for future webinars and what we can do to address that. For now, we do not have the ability to show you the actual database today.

Oh, you wanted to see the actual coding question database. Okay, so I am assuming that is probably not a coder asking that and that is fine. Certainly, if you have a client services login, you can go and access eQuery. It is open to anybody. If you have not used it before, certainly, contact one of your health information management professionals and I am sure they will be happy to show you how to get there. 

We are at time anyways. So, I will close this off right now.

Thanks so much everybody for joining us today. It was my pleasure to present this material to you today. I hope you are walking away from this today with some ideas and thoughts on how to optimize your coding questions and get the responses you need.