Query-Unable to determine

 Query response unable to determine

• ·         When querying for greater specificity of a documented diagnosis, a provider’s response of “unable to determine” would not preclude the coding of the documented diagnosis. The “unable to determine” response would just not allow assignment of a more specific code.

Example: a provider query requests clarification of the type and/or severity of documented congestive heart failure (CHF). If the provider responds “unable to determine”, the CHF diagnosis code would be reported, but the additional specificity would not be able to be represented in the reported code.

• ·         When querying for clinical indicators without a definitive relationship to an underlying diagnosis, a provider’s response of “unable to determine” would preclude the coding of any of the proposed definitive diagnosis(s) options included on the query template. The coder would only assign codes for the signs or symptoms (following ICD-10-CM Official Coding Guidelines) which prompted the query.

• ·         When querying for clarification of whether a diagnosis or condition has been ruled in or ruled out, a provider’s response of “unable to determine” would indicate uncertainty. Coding would follow the ICD-10-CM Official Coding Guidelines for coding “Uncertain Diagnosis.”

ICD-10-CM Official Coding Guidelines - H. Uncertain Diagnosis; If the diagnosis documented at the time of discharge is qualified as “probable”, “suspected”, “likely”, “questionable”, “possible”, or “still to be ruled out”, or other similar terms indicating uncertainty, code the condition as if it existed or was established. The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis.