Q&A: Interpreting unable to determine
Q: In giving choices for responses, our query templates include “other (please specify)” and “unable to determine.” We get many responses of “unable to determine.” How do you interpret the AHIMA/ACDIS Guidelines for Achieving Compliant Query Practices brief with just using “other” in query choice and not using “unable to determine” as well?
A: The most important thing to remember regarding query choices is that you must offer an alternate choice for the provider to freely state whatever the answer may be when they do not agree with the choices provided (assuming most query templates follow a multiple-choice format). “Other, please specify” or “other” offers the provider that flexibility.
Incorporating the phrase “unable to determine” is not a requirement, although the 2019 ACDIS/AHIMA Guidelines for Achieving Compliant Query Practices uses that phrase as an example. It states (p. 9) that “Options may include other unknown, unable to determine, not clinically significant, integral to, or other similar wording.” It further states that “All clinically supported options should be included as well as additional options that permit the provider to craft their own alternate response.”
Ultimately, the Guidelines aim to ensure those who query providers aren’t leading them to select any particular diagnoses based on ulterior motives such as MS-DRG weights, financial reimbursement, or other metrics but solely on the clinical picture of the care for that patient during that encounter.
If your organization sees many “unable to determine” responses to provider queries some additional tracking to identify the specific providers replying in that manner and/or CDI specialists who submit queries garnering those types of responses. Chances are a little bit of additional targeted education could go a long way to explaining the intent behind queries and the importance of thoughtful responses.
Editor’s Note: Dawn Valdez, RN, LNC, CDIP, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at dvaldez@hcpro.com. For information regarding CDI Boot Camps, click here.