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.
No comments:
Post a Comment
Hello, Please let me know if you have any questions