Reference no: EM133144325

SCENARIO: Diego and Michelle were chatting at their cubicles before the coding manager came in for the day. They were having a discussion about the physician query process, and whether it is ever appropriate not to generate a physician query before assigning a questionable code. Michelle believes her productivity suffers when she stops to query physicians about diagnoses and procedures, especially when physicians take a long time to respond to queries. Diego disagrees, stating that his productivity is adequate even though he generates physician queries two to three times each day. Diego reminds Michelle how important it is to determine medical necessity for accurate claims processing, and this often requires coders to query physicians to ensure that documentation supports diagnosis and procedure codes submitted on a claim.

QUESTION: When should a coder generate a physician query?