Query IQ: Are Your Query Templates Friend or Foe?

By Robin Sewell, CCS, CDIP, CPC, CIC, CCDS-O

You can spot a templated query a mile away: Overly long, loaded with generic verbiage, or padded with so much irrelevant detail that the actual question gets lost in translation. It’s like going on a scavenger hunt — without a map. 

At the other end of the spectrum is the dropdown-style template with a simple option to “add” a diagnosis code— a format that carries a high risk of denial. 

In this edition of Query IQ, we’re exploring how to make templates work for you, not against you, and how a thoughtful, concise approach can elevate compliance and clarity and invite fewer query-based denials. 

Customize or Compromise 

Templates are meant to be edited and customized, yet far too often, we see them left unaltered. For example, only a few clinical indicator prompts are filled with copy-and-paste data or irrelevant query options   needlessly take up space on the query form. The ACDIS/AHIMA query practice brief states query options need to be supported by the clinical evidence.  More often than not, pneumonia templates list every possible pneumonia etiology under the sun without clear insight into why the author is posing the question. 

The dropdown-style template with a simple option to “add” a diagnosis code must be carefully edited and tailored to the clinical scenario. Without proper customization, these queries are a compliance risk and may compromise defensibility if the payor denies them. 

Tip: If you’re cutting and pasting or selecting dropdown options more than you are clinically clarifying, it’s time to revise your strategy. 

Queries Should Be Clinically Grounded and Conscise

Think like a scientist. Hassan Rao, MD, Associate Chief Medical Officer and VP, DRG Integrity Service Line at Brundage Group, states that every query you write should reflect a clear hypothesis: Was sepsis present on admission? Could encephalopathy be further clarified as metabolic? Can the labs and clinical context be further clarified as AKI? Is fluid overload an indicator of an acute exacerbation of systolic heart failure? Having clear intent while writing the query allows you to focus on the appropriate clinical indicators and options to provide. The best and easiest queries for providers to answer are the ones that are succinct and concise. While it may not be possible for every clinical scenario, being able to craft a concise query is the mark of a skilled CDI/coder.

Be genuinely curious! 

The structure of your query should match its purpose: 

• If you’re trying to validate something (e.g., sepsis), clearly organize your indicators to reflect the hypothesis and why you’re questioning it. 

• If you’re trying to clarify an omitted diagnosis, be sure the clinical indicators are relevant to the query options and the connection to your hypothesis is clear. Without that focused intent, queries can feel like fishing expeditions — and that opens the door to accusations of authoring a leading query and potential denials. 

Template Truth: One Size Doesn’t Fit All 

You need different templates or structures depending on the scenario: 

• Clinical validation – Keep it tight, focused, and explicitly present supporting and conflicting evidence for the diagnosis in question. 

• Missed diagnosis – Lay out the timeline and clinical indicators and ask a multiple-choice question that reflects your clinical reasoning. (Don’t forget to include the option of Other!) 

Templates are tools — but they should be used with purpose and precision, not as fill-in-the-blank forms where ICD-10 codes are dropped in willy-nilly. 

Compliance is Still King 

It is an art and a science to strike a balance that is neither leading nor vague. But it’s much easier for a provider to understand your intent if you frame the clinical picture clearly: 

“Despite normal vitals and no documented organ dysfunction, sepsis was documented. Please clarify…” 

That’s not leading — that’s thoughtful. And that’s the difference between a query that sparks a response and one that gets ignored (or worse, denied). 

5 Best Practices for Templated Queries 

1. Edit the Template – Always customize. If something doesn’t apply, remove it. If something is missing, add it.  

2. Lead with Purpose – What are you hypothesizing? Write with that intent in mind. 

3. Be Concise – More words ≠ more clarity. Use bullets, short sentences, and clean formatting. 

4. Frame the Hypothesis – Demonstrate clinical reasoning that aligns with the query’s intent and makes sense with the options provided. 

5. Match Structure to Purpose – The format of your query should reflect what you’re trying to accomplish, whether validating a diagnosis or clarifying documentation.