Develop resolutions to address discrepancies in documentation. develop a query t

Question

Develop resolutions to address discrepancies in documentation.

develop a query template modeled after the sample provided below.

Davenport Hospital

Patients Name:

Medical Record Number:        Account :

Discharge Date:

Dr. ______________:

In order to completely and accurately code the diagnoses and procedures for this patient, the following clarification and/or documentation is needed:

Could you please dictate an addendum to your operative report to include the size of the lesion you excised?

Thanks,

Erika

Please add any additional documentation as an addendum to your discharge summary or last progress note.

Please sign and date below:

Explanation / Answer

Davenport Hospital

Medical Record Number:                          Patients Name:

Account:                                                    Discharge Date:

Date:

Subject:

Dr. ______________:

Patient with past medical history of……………………………………., the clinical details are……………………………

The operative document reported:……………………………………….

In order to completely and accurately code the diagnoses and procedures for this patient, the following clarification and/or documentation is needed:

Size of lesion excised to be included in the report.

Please answer this query request.

Thanks,

Erika

Please add any additional documentation as an addendum to your discharge summary or last progress note.

Please sign and date below

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