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Please read the following info to insure you query is asked and answered correctly.

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Coding Queries:

Clinical coders are continually challenged with issues of new developments in medicine, classification constraints and the matching of codes to suit complex clinical situations. A clinical coding query process is essential to provide coding advice, support and education in a collaborative and cooperative partnership between the New Zealand Coding Authority (NZCA).

The clinical coding query process is important for two major reasons. Firstly, it provides an avenue for coders to resolve coding problems they encounter when coding medical records, specifically when there is no applicable standard, directive or instruction in the classification to apply. Secondly, it becomes a feedback mechanism to NZCC and NZCA, highlighting classification and coding issues that impact more broadly throughout the sector. These coding issues can then be more easily identified, investigated and consultation and assistance can be sought nationally at NZHIS and internationally at NCCH.

The new coding query process has been designed to improve communication and consultation around queries, increase sector coder participation, and streamline the process for more efficient query resolution. Resolution of these queries requires extensive research and consultation with clinicians, NZHIS and other MoH coding stakeholders and NZCA.

The committee responsible for addressing coding queries in New Zealand is the NZCA. It is the responsibility of this group to review and discuss the query using documentation, references and clinical advice to decide on either a definitive resolution or an interim resolution for the coding query as appropriate. If the query is significantly complex, requires more comprehensive consultation, or has national and international ramifications, then it will be forwarded to NZCA for advice.

The query submission page has been specifically designed to assist coders in defining their queries, ensuring that the appropriate preliminary steps have been taken to address queries on site, and to provide an avenue through which coders can actively participate in the query resolution process.

Query Submission Process:

There are a number of important steps that a coder must take before submitting a formal query:

• Determine the query type
• Refer to the Australian Coding Standards and advice given in the relevant Coding Matters
• Review the current edition of ICD-10-AM, including any associated errata
• Check the query database to see if any similar/related queries have been recorded
• Reference texts and perform a web search if applicable
• Seek advice from peers/local coding groups and clinicians

Query Type

Queries are divided into three areas: clinical queries, classification queries and coding queries. 

1: Clinical Query. 
Clinical queries are those that relate directly to an understanding of medical science particularly with regard to disease and new developments in procedures. Resolution of these queries will direct the coder to the appropriate code assignment. These queries are usually best dealt with on site. The primary source of resolution will be with clinicians. 

2: Standard Query.
Classification queries are those that relate to specifics of the index and pathways used to find codes. These queries can also revolve around DRG discrepancies. Classification query resolutions generally need to go to NZCA for consultation before submissions are made to the relevant international stakeholders if appropriate.

3: Coding Query.
These queries are specially related to finding a code that matches a clinical scenario when advice is not available in the standards, NCCH database, directives set out in Coding Matters or the NZCA database. They also relate to limitations in the current classification to capture new and advanced medical concepts and new diseases and procedures. Resolution of these queries requires discussion and consultation at NZCA.

ICD-10-AM

The majority of New Zealand coders use the 3M codefinder in their clinical coding practice. While this is an extremely efficient tool, NZCA strongly advises that coders should check their index and also cross reference inclusion and exclusion notes in the ICD-10-AM books before submitting a coding query. Further to this, coders must ensure that their books are updated with all published errata for the current version of ICD-10-AM.

Query Databases

There are two databases available for New Zealand clinical coders to use for the purposes of making sound coding decisions when clarification is required on coding practice. This should be the first line of research done when resolving coding queries. The databases are the NCCH query database and the NZCA query database. It should be noted that these are each different in relation to the application of advice given.  

• The NCCH query database can be accessed on the NCCH website. This database contains queries and advice given for specific clinical scenarios, submitted by Australian state coding advisory committees. These queries and resolutions should be used as a resource only, where coders apply the coding logic to their own individual coding problems. This resource is not a database of NCCH directives and as such should not be used for the purposes of auditing.  
  
• The NZCA query database can be accessed on the NZCA website. This database contains New Zealand based coding directives that are not contained in the standards and are not covered by NCCH directives contained in Coding Matters. NZCA directions contain resolutions to queries considered to have a significant impact on national coding consistency and quality as well as those that specifically address the limitations and problems encountered when using past editions of ICD-10-AM. Because of this, information found in this database should be used when auditing as appropriate.

Research

Coders are encouraged to engage in their own research as part of a proactive approach to resolving their own queries. The results of this research should also be provided as background information for any query that is submitted. 

Peer review and consultation

All coders should share their queries with coding and clinical colleagues for input, advice, assistance and support. 

Query Resolution Process

After coders have gone through the appropriate preliminary steps in attempting to solve their coding query and these steps have not provided the answers they require, a formal query submission can be made. 

All efforts are made to answer queries as quickly as possible. Should there be an extended period of time involved for a query to be resolved, an interim coding response will be given and notification of expected timeframes will be communicated as appropriate. 

The following list indicates the process involved once a query has been submitted. 

1. Submission page is received by the Senior Advisor of Coding Education and the Senior Advisor of Clinical Coding. A receipt is sent to acknowledge this transaction

2. The query will be presented at the New Zealand Coding Authority meeting for discussion. The NZCA meet monthly via teleconference.

3. If the query and resolution sits outside of advice already given in the standards, NCCH directives etc, it will then be recorded on the NZCA database. 

4. Queries that are not able to be resolved at this level will be forwarded to NCCH. Communication of interim coding advice will be given to the individual enquirer as necessary.  Final resolution will be posted on the NZCA website. 

5. Queries that are not able to be solved at NZCA will be referred to NCCH.    

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