CCS Exam Preparation, Domain 3:
Provider Queries Questions &
Answers (Grade A+)
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 answer ✅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?
,CCS Exam Preparation, Domain 3:
Provider Queries Questions &
Answers (Grade A+)
D. Is there a comorbid condition that can be documented to
increase the reimbursement? -
correct answer ✅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 answer ✅A. Query the attending physician regarding the
x-ray finding.
, CCS Exam Preparation, Domain 3:
Provider Queries Questions &
Answers (Grade A+)
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 answer ✅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
Provider Queries Questions &
Answers (Grade A+)
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 answer ✅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?
,CCS Exam Preparation, Domain 3:
Provider Queries Questions &
Answers (Grade A+)
D. Is there a comorbid condition that can be documented to
increase the reimbursement? -
correct answer ✅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 answer ✅A. Query the attending physician regarding the
x-ray finding.
, CCS Exam Preparation, Domain 3:
Provider Queries Questions &
Answers (Grade A+)
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 answer ✅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
