Forms

This 2017 CPT dialysis circuit coding quick reference guide is courtesy of Stacie L. Buck, RHIA, CCS-P, CIRCC, RCC. 

Cheryl Ericson, MS, RN, CCDS, CDI-P, CDI education director for ezDI, donated this sample query related to bile leaks to ACDIS.

Paul Evans, RHIA, CCS, CCS-P, CCDS, manager of regional clinical documentation and coding integrity at SutterHealth in San Francisco, California, offers this sample heart failure query form which includes educational definitions of heart failure, cardiomyopathy and other related concerns. This query originally appeared on the ACDIS website. 

This sample flow chart from ACDIS illustrates the physician query process from initial query submission through to resolution. Lynne Spryszak, RN, CCDS, CPC-A, CDI education director at HCPro, a division of BLR, in Middleton MA, included this chart in the audio conference presentation "Physician Queries Workshop: Tools and Techniques for Compliant, Effective Clarification."

Robert Hodges, BSN, MSN RN, CCDS, and clinical documentation improvement specialist at the Aleda E. Lutz VA Medical Center in Saginaw, Michigan, donated this sample malnutrition query to ACDIS.