CCS EXAM PREPARATION, DOMAIN 3:
PROVIDER QUERIES QUESTIONS
AND ANSWERS
The most challenging type of provider query is issued for:
A. Determining cause and effect
B. Establishing clinical validation
C. Resolving documentation conflict
D. Clarifying acuity or specificity - Correct Answers -B. Establishing clinical validation
The most challenging query type is for clinical validation and may best be addressed by
clinical documentation specialists (AHIMA 2019c).
A patient was admitted with Type 1 diabetes with proliferative diabetic retinopathy to
have surgery for traction retinal detachment for macular edema. Which of the following
questions would make a compliant query for this patient?
A. Was the procedure performed on the left or right eye or bilateral eyes?
B. Is the retinopathy a complication?
C. Will you document use of insulin for this patient?
D. Is there a comorbid condition that can be documented to increase the
reimbursement? - Correct Answers -A. Was the procedure performed on the left or right
eye or bilateral eyes?
Queries cannot be leading, include impact on reimbursement, or direct a physician to
include a specific diagnosis. Therefore, clarification of which eye the procedure is on is
the only compliant query question (AHIMA 2019c).
A patient has findings suggestive of chronic obstructive pulmonary disease (COPD) on
chest x-ray. The attending physician mentions the x-ray finding in one progress note but
no medication, treatment, or further evaluation is provided. The coding professional
should:
A. Query the attending physician regarding the x-ray finding.
B. Code the condition because the documentation reflects it.
C. Question the radiologist regarding whether to code this condition.
D. Use a code from abnormal findings to reflect the condition. - Correct Answers -A.
Query the attending physician regarding the x-ray finding.
, A 56-year-old woman is admitted to an acute-care facility from a skilled nursing facility.
The patient has multiple sclerosis and hypertension. During the course of
hospitalization, a decubitus ulcer is found and debrided at the bedside by a physician.
There is no typed operative report and no pathology report. The coding professional
should:
A. Use an excisional debridement code as these charts are rarely reviewed to verify the
excisional debridement.
B. Code with a non-excisional debridement procedure code.
C. Query the healthcare provider who performed the procedure to determine if the
debridement was excisional.
D. Eliminate the procedure code all together. - Correct Answers -C. Query the
healthcare provider who performed the procedure to determine if the debridement was
excisional.
Excisional debridement can be performed in the operating room, the emergency
department, or at the bedside. Coding professionals are encouraged to work with the
physician and other healthcare providers to ensure that the documentation in the health
record is very specific regarding the type of debridement performed. If there is any
question as to whether the debridement is excisional or non-excisional, the provider
should be queried for clarification (Schraffenberger and Palkie 2022, 426- 427).
When creating compliant queries coding professionals should:
A. Query once without further follow up
B. Query multiple times until the desired diagnosis is provided
C. Query once with additional follow up if necessary
D. Query unlimited times until every discrepancy is resolved - Correct Answers -C.
Query once with additional follow up if necessary
AHIMA's Guidelines for Achieving a Compliant Query Practice instruct that additional
queries may be necessary based on the information provided in the first query
response. It is permissible to issue another query in that circumstance (AHIMA 2019c).
A patient is admitted to the hospital with a high fever, chills, tachycardia, and a
respiration rate of 26. Lactic acidosis is noted in the labs. Pneumonia is diagnosed and
the patient admitted to ICU where antibiotics are given along with Levophed to help
maintain the patient's blood pressure which was in the extremely low range. The
patient's breathing was erratic and mechanical ventilation was initiated. With a final
diagnosis of pneumonia, what is the query opportunity for this record?
A. Is this aspiration pneumonia?
B. Is this septic shock?
C. Is this Staphylococcus aureus pneumonia?
D. Is this sepsis? - Correct Answers -B. Is this septic shock?
The clinical indicators of fever, chills, tachycardia, tachypnea, and lactic acidosis all
point to sepsis, but with the addition of respiratory issues requiring mechanical
ventilation, and circulatory failure requiring the use of vasopressors, this condition more
PROVIDER QUERIES QUESTIONS
AND ANSWERS
The most challenging type of provider query is issued for:
A. Determining cause and effect
B. Establishing clinical validation
C. Resolving documentation conflict
D. Clarifying acuity or specificity - Correct Answers -B. Establishing clinical validation
The most challenging query type is for clinical validation and may best be addressed by
clinical documentation specialists (AHIMA 2019c).
A patient was admitted with Type 1 diabetes with proliferative diabetic retinopathy to
have surgery for traction retinal detachment for macular edema. Which of the following
questions would make a compliant query for this patient?
A. Was the procedure performed on the left or right eye or bilateral eyes?
B. Is the retinopathy a complication?
C. Will you document use of insulin for this patient?
D. Is there a comorbid condition that can be documented to increase the
reimbursement? - Correct Answers -A. Was the procedure performed on the left or right
eye or bilateral eyes?
Queries cannot be leading, include impact on reimbursement, or direct a physician to
include a specific diagnosis. Therefore, clarification of which eye the procedure is on is
the only compliant query question (AHIMA 2019c).
A patient has findings suggestive of chronic obstructive pulmonary disease (COPD) on
chest x-ray. The attending physician mentions the x-ray finding in one progress note but
no medication, treatment, or further evaluation is provided. The coding professional
should:
A. Query the attending physician regarding the x-ray finding.
B. Code the condition because the documentation reflects it.
C. Question the radiologist regarding whether to code this condition.
D. Use a code from abnormal findings to reflect the condition. - Correct Answers -A.
Query the attending physician regarding the x-ray finding.
, A 56-year-old woman is admitted to an acute-care facility from a skilled nursing facility.
The patient has multiple sclerosis and hypertension. During the course of
hospitalization, a decubitus ulcer is found and debrided at the bedside by a physician.
There is no typed operative report and no pathology report. The coding professional
should:
A. Use an excisional debridement code as these charts are rarely reviewed to verify the
excisional debridement.
B. Code with a non-excisional debridement procedure code.
C. Query the healthcare provider who performed the procedure to determine if the
debridement was excisional.
D. Eliminate the procedure code all together. - Correct Answers -C. Query the
healthcare provider who performed the procedure to determine if the debridement was
excisional.
Excisional debridement can be performed in the operating room, the emergency
department, or at the bedside. Coding professionals are encouraged to work with the
physician and other healthcare providers to ensure that the documentation in the health
record is very specific regarding the type of debridement performed. If there is any
question as to whether the debridement is excisional or non-excisional, the provider
should be queried for clarification (Schraffenberger and Palkie 2022, 426- 427).
When creating compliant queries coding professionals should:
A. Query once without further follow up
B. Query multiple times until the desired diagnosis is provided
C. Query once with additional follow up if necessary
D. Query unlimited times until every discrepancy is resolved - Correct Answers -C.
Query once with additional follow up if necessary
AHIMA's Guidelines for Achieving a Compliant Query Practice instruct that additional
queries may be necessary based on the information provided in the first query
response. It is permissible to issue another query in that circumstance (AHIMA 2019c).
A patient is admitted to the hospital with a high fever, chills, tachycardia, and a
respiration rate of 26. Lactic acidosis is noted in the labs. Pneumonia is diagnosed and
the patient admitted to ICU where antibiotics are given along with Levophed to help
maintain the patient's blood pressure which was in the extremely low range. The
patient's breathing was erratic and mechanical ventilation was initiated. With a final
diagnosis of pneumonia, what is the query opportunity for this record?
A. Is this aspiration pneumonia?
B. Is this septic shock?
C. Is this Staphylococcus aureus pneumonia?
D. Is this sepsis? - Correct Answers -B. Is this septic shock?
The clinical indicators of fever, chills, tachycardia, tachypnea, and lactic acidosis all
point to sepsis, but with the addition of respiratory issues requiring mechanical
ventilation, and circulatory failure requiring the use of vasopressors, this condition more
