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CDI: Just Tell Me What to Say

Simplifying the Query Process with Directed Step

Published October 7, 2013 2:12 PM by Mark Dominesey

According to Merriam-Webster's online dictionary, query is a transitive verb. It requires one or more objects. To "query" someone is to ask questions in order to resolve a doubt or obtain authoritative information. CDI specialists (CDIS) and clinical coders query physicians every day to clarify documentation and achieve accurate code assignments.

In fact, 38 percent of facilities have a set query quota (amount of cases CDIS's should query). And for over 50% of CDIS's, this quota is at least 15% of all the charts they review.1 Thousands of physician queries are created and answered every day.

However, the query process remains confusing, complicated and in some cases, non-compliant with clinical coding standards. Physicians are often dissatisfied and fail to respond to CDI or coder questions. Physician apathy / lack of response and interest ranks top concern by over 50% of CDISs in a recent ACDIS survey.2

Simplifying physician queries benefits everyone: CDISs, coders and physicians. Directed step queries are one way to get the job done.

What are Directed Step Queries?

The Directed Step Query is patent-pending process designed with physicians' needs in mind. The process has a provisional patent application registered with the US Patent office*. Directed Step queries provide an answer to the question, "just tell me what you want me to do".

Directed Step queries incorporate a coherent, logical series of steps and do not favor one answer over another. Physicians are asked to take "steps" to follow and respond to the query.

Electronic or paper-based, Directed Step queries incorporate the following four components:

  • Query Title
  • Patient Demographic Information
  • Query Instructions
  • CDIS/Coder Narrative

How to Build Them

The first step in building a Directed Step query is to choose the specific diagnosis. From there, CDIS would consider causation, etiology or relationships to other diagnoses. Space is provided (electronic or paper) for physician narrative, physician accepted definition or reference, additional reminder if indicated, physician signature, CDI review and re-review dates, and coder feedback. Multiple steps and additional queries can be added to the initial Directed Step query.

Boosting Physician Response

Physician response to queries is the magic indicator of your success. If your facility has a lower than 50% physician query response rate, Directed Step queries may help. However, these three factors are necessary to successfully launch a Directed Step query program.

Physician Participation

Solicit clinical content from relevant specialist groups and use already-established clinical parameters and definitions. Obtain Medical Executive Committee approval.

Administrative Support

Garner C-suite sponsorship of your program and agreement from the CMO, CMIO and HIM Director.

Ongoing Audits

Audit your queries for accuracy, relevance and compliance. Report your findings and make program adjustments along the way. Guidelines for achieving a compliant query practice are available from AHIMA/ACDIS here:

Final Advice

Queries aren't easy. But they are necessary and can be simplified by using the Directed Step approach. And when combined with other effective strategies, such as one-on-one conversations and educational presentations at medical staff meetings, they will successfully boost your query response rates.

CDIS's and coders have a lot of new issues on their plates in the next twelve months-worrying about physician queries shouldn't be one of them.

*NOTE: For more information about the Directed Step Query patent-pending process, contact Mark Dominesey at TrustHCS:

1. Physician Query Benchmarking Report. ACDIS. January 2011. Available online at:

2. CDI Industry Overview: Emerging Topics. 2013 CDI Week. ACDIS. September 2013. Available online at:

posted by Mark Dominesey


This area is very informative and helpful to us who are preparing for the ICD 10 implementation.

Virley Fortner January 28, 2015 7:11 PM

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