An AAPC blog post discusses the essential elements of knowing when to query providers for coding updates, especially with the ICD-10 transition.
Coders should query providers:
1. If there is conflicting information in the medical record.
2. If there is incomplete information in the medical record like missing test results.
3. Significant reportable conditions or procedures that require more information for correct coding.
4. Unspecified diagnosis documentation when clinical reports suggest a more specific diagnosis.
At the same time, queries should not question the provider's clinical judgment or focus on clinically insignificant findings.