1. You are a CDI specialist working in a hospital that uses

an electronic health record (EHR) system. You receive a

query from a physician who is documenting the care of a

patient with sepsis. The query asks you to confirm the

source of infection, the severity of sepsis, and the presence

of any organ dysfunction. The query is sent through the

EHR system and has a deadline of 24 hours. Which of the

following statements is true about this query?

 A) The query is compliant because it is specific, relevant,

and timely.

 B) The query is non-compliant because it is leading,

suggestive, and coercive.

 C) The query is non-compliant because it is vague,

ambiguous, and unclear.

 D) The query is compliant because it is concise, objective,

and respectful.

 Answer: A) The query is compliant because it is specific,

relevant, and timely. A compliant query should be clear

and precise, related to the clinical scenario, and have a

reasonable timeframe for response. The query should also

avoid leading or influencing the physician's documentation,

or implying a desired outcome.

2. You are a CDI specialist working in a hospital that uses

a paper-based documentation system. You receive a query

from a physician who is documenting the care of a patient

with acute myocardial infarction (AMI). The query asks

you to add the terms "STEMI" or "NSTEMI" to the

diagnosis, depending on the results of the