ࡱ> }~ bjbj Hcc0~ ~ )))8at)ka!w!!!!y#y#y#$+hQy#W#"y#y#y#!!%+++y#f8!!+y#++&&!Ш܆ '$fd;0kIE&I8Iy#y#+y#y#y#y#y# )y#y#y#ky#y#y#y#Iy#y#y#y#y#y#y#y#y#~ : DOCUMENTATION CLARIFICATION QUERIES These sample physician query documents are offered solely as examples of standardized physician queries to clarify clinical documentation within the medical record. These query documents were created based on our interpretation of AHIMA/ACDIS guidelines and may be used by healthcare facilities at their own discretion. Pinson and Tang. LLC makes no representation, guarantee or warranty with respect to these query documents, including with respect to their compliance with any relevant state, federal or other guidance. It is the sole responsibility of the healthcare facility to review and modify these examples as needed to ensure they meet their own compliance policies and standards, as well as the standards of any applicable state or federal regulatory entity. These templates are considered a copyrighted work under the United States and other copyright laws and the property of Pinson and Tang, LLC. Healthcare facilities may make archival copies and customize this template only for the limited use of their facility or organization and not for resale or public sharing. This template and any customized or modified version of this template may NOT be sold, distributed, published to an online gallery, hosted on a website, or placed on a public server. If any questions regarding this limited use license, contact  HYPERLINK "mailto:Ctang@PinsonandTang.com" Ctang@PinsonandTang.com. Recommendations for use: These query templates are designed for use as Word documents or e-messages and the content is to be edited and customized for the specific findings in each case. Suggested indicators not present in a particular case and/or multiple choice response options not supported by indicators (e.g., acute heart failure with only chronic indicators) should be deleted prior to submission to the provider. Content within brackets should be completed or deleted. Titles of each template are for reference only and should not appear on queries submitted to providers. 2016 Pinson and Tang, LLC. All Rights Reserved. DOCUMENTATION CLARIFICATION QUERIES Table of Contents TopicPage No.Acute Coronary Syndrome3Acute Kidney Injury (AKI)4Acute Tubular Necrosis5Anemia, Acute Blood Loss6BMI > 407BMI < 198Chest Pain9CHF specify type only10CHF specify type and acuity11CKD Stage12Debridement, Excisional13Depression14Diabetic Gastroparesis15Diabetic Complications16Encephalopathy17Encephalopathy causing Delirium18Functional Quadriplegia19GI Bleeding20HIV/AIDS21Hypertension (Crisis / Emergency)22Malnutrition, severity23Malnutrition, not yet diagnosed24Pathologic / Osteoporotic Fracture25Pancytopenia26Pneumonia, Healthcare Associated (HCAP) 27-28Pneumonia, Aspiration29Pressure Ulcer30Respiratory Failure, Acute31Respiratory Failure, Chronic32Schizophrenia33Sepsis34Syncope35TIA36Urosepsis37Probable/suspected cause of symptoms38Specific diagnostic condition 39Clarification of a conflicting diagnosis40Confirmation of a diagnosis 41Clinical validation query42General query template43 [Acute Coronary Syndrome] Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having ACUTE CORONARY SYNDROME. Based on your medical judgment, can you further clarify in the progress notes which, if any, of the following this condition is intended to indicate: Transmural MI Subendocardial MI STEMI NSTEMI Unstable angina Other diagnosis (please specify) Not applicable / none of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Acute Kidney Injury] Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having______________________________________________________. The following lab is also documented in the medical record: ( Creatinine on admission = _______ Baseline creatinine [if known]: _______ ( Correction of creatinine from ________ to ________ following rehydration ( Creatinine increasing from _______ to _________ between ______ and _____ [dates] ( Urine output ______ cc over ____ hours [if >6 hours and meets cc/kg/hr criteria] Based on your medical judgment, can you further clarify in the progress notes which, if any, of the following these findings suggest: Acute kidney injury (AKI) / acute renal failure Acute on chronic renal failure Chronic kidney disease / chronic renal failure (Please specify Stage) Other condition Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Acute Tubular Necrosis (ATN)] Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having Acute Kidney Injury (AKI). Include the following clinical findings, as applicable, which support the query for ATN: Prolonged elevation of creatinine (> 72 hours) Oliguria (low urine output specified in cc/hr over what time period) Hypotension (include specific blood pressure readings) IV contrast administration Nephrotoxic medication The following is also documented in the medical record: Serial creatinine levels [and dates]: FENa = Urinary sodium concentration: Urinalysis [if applicable]: Other circumstances: Based on your medical judgment, can you further clarify in the progress notes the likely cause of the acute renal failure or insufficiency in this case such as: Acute Tubular Necrosis Acute Cortical Necrosis Acute Glomerulonephritis Pre-Renal Acute Kidney Injury/Renal Failure Another condition (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Acute Blood Loss Anemia] Documentation in the medical record indicates the following: Anemia Drop in Hgb from ___ to ___ GI bleeding Hypotension Blood transfusion of __ units Other Based on your medical judgment, can you further clarify in the progress notes which, if any, of the following conditions are responsible for these findings: Acute blood loss anemia Chronic blood loss anemia Acute on chronic blood loss anemia Acute hemorrhagic anemia Iron deficiency anemia Other anemia (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [BMI >40] Documentation in the medical record indicates that this patient has: BMI = Other documentation includes: Based on your medical judgment, can you further clarify in the progress notes which, if any, of the following conditions are associated with this BMI: Overweight Obesity Morbid obesity Other condition (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [BMI < 19] Documentation in the medical record indicates that this patient has: BMI = Other documentation includes: Based on your medical judgment, can you further clarify in the progress notes which, if any, of the following conditions are associated with this BMI: Underweight Malnutrition if so please document severity Undernutrition Anorexia Other condition (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Chest Pain] Based on the documentation in the medical record, this patient was admitted with CHEST PAIN. Other information in the medical records includes: Based on your medical judgment, is the chest pain most likely, possibly, probably due to any of the following causes: Coronary artery diseasePleurisyBiliary colicGERD/refluxCostochondritisAnxietyDyspepsiaGastritisHyperventilation syndromeCholelithiasisCholecystitisChest wall painEsophagitis or spasmHiatal herniaPeptic ulcerOther diagnosis (please specify) % Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [CHF specify type only] Documentation in the medical record indicates that this patient is being treated for HEART FAILURE / CHF. Echocardiogram reports EF of __________ An EF of _____ is documented [location / by whom] The patient has a history of [ESRD / Hypertension / Coronary artery disease] Medications include: Chest x-ray shows: BNP = Other documentation and findings include: Based on your medical judgment, can you further clarify in the progress notes the precise nature of the patients heart failure/dysfunction for this admission such as: SYSTOLIC DIASTOLIC COMBINED SYSTOLIC/DIASTOLIC Other (please specify) Not Applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [CHF Specify type and acuity] Documentation in the medical record indicates that this patient is being treated for HEART FAILURE or CHF. Echocardiogram reports EF of __________ An EF of _____ is documented [location / by whom] The patient has a history of [ESRD / Hypertension / Coronary artery disease] Medications include: ___________________________________________________ Chest x-ray shows: _____________________________________________________ BNP = ________ Other documentation and findings include: Based on your medical judgment, can you further clarify in the progress notes the precise nature and severity of the patients heart failure for this admission, such as: Systolic Diastolic Combined Exacerbation / Decompensation (Acute) Acute on Chronic Chronic Other (please specify) Not Applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [CKD Stage] Based on the clinical information documented in the medical record, this patient has been diagnosed with Chronic Kidney Disease, Failure or Insufficiency. Lab reports show a stable GFR of ____ to ____ from _______ to ________. StageGFRCKD Stage 1> 90CKD Stage 260 89CKD Stage 330 59CKD Stage 415 29CKD Stage 5< 15ESRDNeed for dialysis Based on your medical judgment, can you further clarify the appropriate stage of CKD in the progress notes? In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected.  [Debridement, Excisional] Based on the documentation in the medical record, this patient has undergone WOUND CARE and/or WOUND DEBRIDEMENT. Based on your medical judgment, can you further clarify the precise nature, depth, extent and/or methods of wound debridement utilized in this case, such as: EXCISIONAL debridement (use of a scalpel/blade to cut away tissue) NON-EXCISIONAL debridement (chemical, scrubbing, trimming with scissors) Other debridement (please specify) Other / Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Depression] Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having DEPRESSION. The following is also documented in the medical record: _________________________________________________________________________ Based on your medical judgment, can you further clarify in the progress notes the status of this patients DEPRESSION: Type Major depression Simple depression Severity Mild Moderate Severe Remission status In remission Not in remission Other (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Diabetic Gastroparesis] Documentation in the medical record indicates that this patient has been diagnosed with DIABETES and is being treated for [GASTROINTESTINAL disorder]. Additional findings also documented in the medical record include [include all that apply]: Vomiting without diarrhea Distended stomach History of similar or repeated episodes History of peripheral or autonomic neuropathy Abdominal pressure or swelling Treatment with Reglan (metoclopromide) Other (please specify Not applicable / None of the above Based on your medical judgment, can you further clarify in the progress notes a specific diagnosis, if any, related to these gastrointestinal symptoms/findings and the patients diabetes? In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Diabetic Complications] Documentation in the medical record indicates that this patient has been diagnosed with DIABETES and [the related complicating condition] Additional findings include: Based on your medical judgment, can you further clarify in the progress notes whether or not the [related complicating condition] is due to diabetes? Other (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Encephalopathy] Documentation in the medical record indicates that this patient has been diagnosed as having the symptom of ALTERED MENTAL STATUS. Additional findings also documented in the medical record include: [include all the apply] Fever Infection Dehydration / electrolyte imbalance Sepsis / SIRS Hypoxia Hepatic / renbal failure Abnormal lab tests: Drug toxicity or adverse effect: Based on your medical judgment, can you further clarify in the progress notes any underlying neurologic cause, condition or process, if any, represented by this symptom including: Metabolic Encephalopathy Toxic Encephalopathy Toxic-Metabolic Encephalopathy Coma Other condition (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Encephalopathy causing Delirium] Documentation in the medical record indicates that this patient has been diagnosed as having the symptom of DELIRIUM. Additional findings also documented in the medical record include: [include all that apply] Fever Infection Dehydration / Electrolyte imbalance Sepsis/SIRS Hypoxia Hepatic/Renal Failure Abnormal lab tests: Drug toxicity or adverse effect: Based on your medical judgment, can you further clarify in the progress notes the underlying cause, if any, of delirium including: Metabolic encephalopathy Toxic encephalopathy (drugs / toxins) Toxic-Metabolic encephalopathy A mental illness / disorder (please specify) Circumstantial stress and/or sleep deprivation Other (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Functional Quadriplegia] Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having: [include all that apply] Severe dementia Total care Activity level: Bedfast Mobility level: Completely immobile, or very limited Feeding tube Extreme / severe neurologic deficits Urinary / bowel incontinence Flexion contractures Other severe disability condition: Based on your medical judgment, can you further clarify in the progress notes which, if any, of the following do the above conditions indicate (more than one if appropriate): Functional Quadriplegia Quadriparesis Coma Severe debility only Paralysis Other (please specify) Not applicable / None of the above/ In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [GI Bleeding] Documentation in the medical record indicates that this patient has been identified to have and/or is being treated for GI BLEEDING. EGD / Colonoscopy findings: __________________________________________________ ___________________________________________________________________________ Other information in the medical record includes: __________________________________ Based on your medical judgment, can you further clarify in the progress notes whether or not the GI bleeding is due to the [lesion(s) identified] ? Other cause of GI bleeding (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [HIV/AIDS] Documentation in the medical record indicates the patient has: HIV [or HIV infection] and Current and/or prior CD4+ T-lymphocyte count of ________ and/or a history of the following conditions: Based on your medical judgment, can you further clarify the HIV status of this patient: HIV positive only / HIV infection (without AIDS) HIV disease (AIDS) Other condition (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Hypertensive Crisis / Emergency] Documentation in the medical record indicates that this patient is being treated for Hypertension The following is also documented in the medical record : Systolic BP consistently in the range of ___ to ___ from [dates] Diastolic BP consistently in the range of ___ to ___ from [dates] Other clinical findings [list any symptoms, diagnoses or evidence of organ dysfunction that might be due to hypertension]: IV or STAT anti-hypertensive medications [includes oral Clonidine]: _____________________________________________________________________ Based on your medical judgment, can you further clarify in the progress notes whether the severity of hypertension in this case represents any of the following: Hypertensive Crisis Hypertensive Emergency Hypertensive Urgency only Benign Hypertension only Hypertension without further specification Another condition (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Malnutrition - severity] The medical record indicates that this patient has been diagnosed as having MALNUTRITION with the following findings documented: Clinical Findings [include all those that apply]: BMI < 16 (include actual BMI) Weight < 70% of ideal body weight (IBW) Weight < 75% of usual body weight (UBW) Unintended weight loss of > 5% in one month, > 7.5% in 3 months, > 10% in 6 months, or > 20% in one year: Recent weight loss of _______ pounds over _______ months Decreased hand grip strength Albumin and/or Prealbumin (if significantly low and not explained by other circumstances) Muscle wasting/atrophy Cachexia High risk circumstances: [Cancer, malabsorption, other severe chronic GI disorder, debilitated, not eating, lack of social support, nursing home, other severe end-stage disease specified, alcohol/drug abuse] Nutrition Consult: Nutritional Supplementation: Based on your medical judgment, can you further clarify in the progress notes the SEVERITY OF MALNUTRITION: Mild Moderate Severe Other (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Malnutrition not yet diagnosed] The following information is documented in the medical record regarding this patients nutritional status: Clinical Findings: Nutrition Consult: Nutritional Supplementation: Based on your medical judgment, can you further clarify in the progress notes which, if any, of the following conditions (and the severity, if applicable) may be causing these findings: Malnutrition Weight loss only Underweight only Nutritional deficiency (please specify) Another cause (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Pathologic / Osteoporotic Compression Fracture] [THIS QUERY NOT NEEDED FOR OSTEOPOROSIS IF IT IS DOCUMENTED ANYWHERE IN THE MEDICAL RECORD AND ONLY MINOR TRAUMA] Dear Dr. ______________________________________________ Documentation in the medical record indicates that this patient has been diagnosed with VERTEBRAL COMPRESSION FRACTURE(S) [spontaneously or following minor trauma] Other documentation in the medical record includes: [describe underlying cause like neoplasm and any mets] [multiple other compression fractures, if any] ( Imaging: [describe X-ray, CT, and/or MRI] ( Medications: [for osteoporosis or neoplasm] ( Osteopenia on _________ X-ray Based on your medical judgment, can you further clarify in the progress notes the most likely underlying cause of the Compression Fracture(s)? In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Pancytopenia] Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having [all that apply]: Anemia Neutropenia or Leukopenia Thrombocytopenia The following is also documented in the medical record: Hemoglobin = ____ Gm/dl Absolute Neutrophil Count (ANC) = ______ Platelets = _________ Other information [any pertinent]: Based on your medical judgment, can you further clarify in the progress notes which, if any, of the following these findings suggest: Pancytopenia, unspecified cause Pancytopenia due to chemotherapy Pancytopenia due to radiotherapy Pancytopenia due to another drug Another condition (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. INSTRUCTIONS COMPLEX PNEUMONIA QUERY On the following query, include the following clinical findings and risk factors, as applicable, which support the query for a more complex type of pneumonia, such as staph, gram-negative, aspiration or other complex pneumonia. If the patient has specific clinical indicators for aspiration, it may be more effective to use the Aspiration Pneumonia query. HCAP: The predominant organisms causing HCAP (>80%) are gram-negative and staph . Antibiotics given ought to be those active against these organisms (see the CDI Pocket Guide). Note: Patients who are receiving only antibiotics such as Rocephin, Zithromax, Quinolones (Levaquin or Avelox), or Doxycycline are usually being treated for a simple pneumonia, and this query may not be appropriate. Levaquin and Avalox are sometimes used for aspiration pneumonia. Cipro is sometimes used for Pseudomonas. Sometimes the physician may not have recognized aspiration as the cause and is not using an antibiotic for aspiration. Clinical Findings: RLL infiltrate (aspiration) Open wound or ulcer (staph) IV catheter (staph) Structural lung disease like bronchiectasis (usually Pseudomonas) Recent antibiotic treatment Recent hospitalization Risk Factors: Immuno-suppressed state Alcoholism / Drug abuse Ventilator status ESRD (often staph) Chronic debilitation GERD/esophageal disorder (aspiration) G-tube (aspiration) COPD (usually gram negative) Cancer Chemotherapy Steroids [Pneumonia, Healthcare Associated (HCAP)] Based on the documentation in the medical record, this patient has been diagnosed with HCAP (Healthcare Associated Pneumonia) but without definitive culture confirmation. Additional documentation in the medical record suggests a likely or probable organism(s) causing pneumonia: Antibiotics: Other clinical information: _[include any clinical indicators suggesting or associated with gram-negative and/or staph] Based on your medical judgment, can you further clarify in the progress notes whether HCAP in this case (for which these antibiotics are being given in these circumstances) is suspected, most likely, possibly, probably related to one or more of the following: Aspiration MRSA Other Staph Gram negative Pseudomonas H. influenza Pneumococcus Another organism (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Aspiration Pneumonia] Based on the documentation in the medical record, this patient has been diagnosed with PNEUMONIA. The following information is also documented in the medical record which may indicate a more specific type or cause of pneumonia: ______________________________________________________________________ [Include the following as applicable, which support the query for aspiration pneumonia: Clinical Findings: RLL Infiltrate, vomiting, difficulty swallowing, impaired gag reflex, altered level of consciousness, abnormal swallowing study (normal study does not rule-out aspiration). Risk Factors: Nursing home status, history of stroke / neurodegenerative disorder (e.g. MS, ALS), debilitated state / bed-confined, altered level of consciousness, alcoholic / drug intoxication or abuse, NG-tube, esophageal disorder (e.g. cancer, obstruction, stricture, etc.) / GERD. Antibiotic treatment: Clindamycin, Flagyl, Zosyn, Augmentin, Levaquin, Avelox] Based on your medical judgment, can you further clarify in the progress notes the likely or suspected underlying cause, if any, of the pneumonia in this case? In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected.  [Pressure Ulcer] Documentation in the medical record indicates that this patient has been identified to have and/or is being treated for PRESSURE ULCER(s) of the following sites: Please clarify the location/sites and the present on admission status of the ulcer(s) in the progress notes. In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Respiratory Failure, Acute] Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having______________________________________________________. The following is also documented in the medical record: Respiratory symptoms: _________________________________________________ Respiratory Rate: ____________ pO2 = _____ [and/or SpO2 = ____] on room air pCO2 = _____ with pH = _____ P/F Ratio = ________ [if reported on ABG] Treatment: [O2 % or L/min; BiPAP; CPAP; Ventilator; bronchodilator] Based on your medical judgment, can you further clarify in the progress notes which, if any, of the following this condition is intended to indicate: Acute hypoxic respiratory failure Acute hypercapnic respiratory failure Acute on chronic respiratory failure Chronic respiratory failure Hypoxemia only without respiratory failure Other Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Respiratory Failure, Chronic] Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having ______________________________________________________. The following is also documented in the medical record [mark all that apply]: ( End-stage lung disease ( Severe COPD ( Home oxygen therapy at ____L/min ( Elevated pCO2 = __________ ( Elevated HCO3 = __________ ( Pulse ox (SpO2) = on ________ [O2 % or L/min on room air] ( pO2 on ________ [O2 % or L/min on room air] ( Other:_________________________________________________________ Based on your medical judgment, can you further clarify in the progress notes which, if any, of the following condition(s) is responsible for these findings: Chronic respiratory failure Abnormal blood gases only Another condition (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Schizophrenia] Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having SCHIZOPHRENIA. The following is also documented in the medical record: Based on your medical judgment, can you further clarify in the progress notes the nature of this patients schizophrenia : Acuity Acute Chronic Remission status In remission Not in remission Other (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Sepsis] Based on documentation in the medical record, this patient is being treated for: _________________________________________________________________________ The following criteria are also documented in the medical record [include only those that apply]: Temperature = WBC = Pulse = Respirations = Lactate = Hypotension: Hypoxemia; SpO2 = ____ % on _____ O2 Acute kidney injury Acute respiratory distress/failure Mental status change / encephalopathy Based on your medical judgment, can you further clarify in the progress notes the cause, if any, of these systemic findings including: Sepsis Septicemia A localized infection only (without sepsis/septicemia) Non-infectious SIRS Another condition (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Syncope] Documentation in the medical record indicates that this patient was admitted for or with SYNCOPE. Other documentation in the medical record includes: ___________________________________________________________________________ Based on your medical judgment, can you further clarify in the progress notes the most likely, possible, probable underlying cause, if any, of this symptom such as: Cardiac arrhythmiaStructural/valvular heart diseaseCardiovascular medicationCerebrovascular occlusion (partial or complete)Anemia / GI bleedingSeizure DisorderAV blockAutonomic neuropathyDehydration HypoglycemiaVaso-vagal / vaso-depressor Another condition (please specify)Not applicable / None of the above  In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [TIA] Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having TIA. The following information is also documented in the medical record: Duration of symptoms: __________________________________ Atrial fibrillation Abnormal Heart Valve(s) Recent MI Carotid Doppler showing: Echocardiogram showing: MRI or MRA showing: Treatment with ASA Aggrenox Persantin Plavix Coumadin Other: ______________________________________________________________ Based on your medical judgment, can you further clarify in the progress notes the possible, probable, likely, suspected underlying cause, if any, of the TIA symptoms such as: Stroke / CVA Transient cerebral thrombosis (without CVA) Transient cerebral embolism (without CVA) Occlusion or stenosis of a precerebral/cerebral artery (partial or complete) please specify suspected artery Another cause (please specify) Not applicable / None of the above In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Urosepsis] Based on the documentation in the medical record, this patient is being treated for or diagnosed with UROSEPSIS. Urosepsis is no longer a codeable diagnosis and we need help with clarification of the intended meaning. Based on your medical judgment, can you please further clarify in the progress notes whether this term is intended to indicate: UTI ONLY SEPSIS DUE TO UTI In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. [Probable/suspected cause of symptoms] Documentation in the medical record indicates the following: Based on your medical judgment, can you further clarify in the progress notes the most LIKELY, PROBABLE OR SUSPECTED CAUSE OF THIS CONDITION In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. Please note that your response may include: Not applicable or none. [Specific Diagnostic Condition] Documentation in the medical record indicates the following: Based on your medical judgment, can you further clarify in your progress notes a SPECIFIC DIAGNOSTIC CONDITION associated with or causing the above findings or symptoms? In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. Please note that your response may include: None or not applicable. Clarification of Conflicting Diagnoses We need your assistance resolving some conflicting information in the medical record. Dr. ____________________ documented the following diagnosis in his/her note on [Date]: Dr. ____________________ documented the following diagnosis in his/her note on [Date] Other documentation in the medical record also indicates: [information that supports the diagnosis and/or causes conflict]: Based on your medical judgment, please clarify in the progress notes which, in your opinion, is the correct diagnosis in this case. Please note that your response may include: None of the above (please explain) or another diagnosis (please specify). In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. Confirmation of a Diagnosis The following diagnosis is documented in the record only once: Other supporting information documented in the medical record includes: Based on your medical judgment, please clarify in the progress notes whether or not this patient actually has this diagnosis or, if not, another diagnosis (please specify)? Please note that your response may include: Neither the documented diagnosis nor another one. In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected. Clinical Validation Your assistance with confirmation of a documented diagnosis is requested because we cannot identify adequate information in the medical record to support code assignment in this case. Diagnosis: ______________________________________________________ Would you please clarify in the patient medical record whether: This diagnosis is not confirmed and/or it has been ruled out. 2. 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