The Many Meanings of "Unable to Determine"

Queries written in a multiple-choice format include a short list of options for physician response. These options must be relevant and supported by the clinical indicators included in the query. In the event a physician cannot provide a specific answer by using one of these listed options, there must be an additional option for “unable to determine.” “Unable to determine” (or similar phrases such as “undetermined” or “unspecified”) means the provider is clinically unable to determine if the diagnosis, or further specificity of the diagnosis, can be given. This is not the same as “unable to rule out,” and does not indicate an uncertain diagnosis, such as possible, probable, likely, etc. .” Each facility should review queries answered as “unable to determine” on a case-by-case basis in the instance that further escalation is needed, as outlined in the AHIMA and ACDIS “Guidelines for Achieving a Compliant Query Practice” (2022 Update) under “General Query Guidelines.

When writing POA and YES/NO queries, the option of “Unable to determine” is always required. (PLEASE NOTE:  The examples below only contain the question and options for response.  The coder would also need to include any relevant clinical indicators to support the query.)

POA Query

When writing queries for POA, the option of “unable to determine” must be included. “Unable to determine” means the physician cannot confirm that the condition was present at the time of admission. This response is only addressing the POA status, not if the condition is ruled in or ruled out. The condition would not be used as principal diagnosis with a POA status of “unable to determine.”

Question:  Was pneumonia present at the time of admission?

• Yes
• No
• Unable to determine

Further Specificity Query

Many times further specificity is required for a condition, such as acuity or type. In these cases, a response of “unable to determine” is essentially stating “unspecified.” For the example below, there would be no need to include a separate option for “Pneumonia, unspecified” since “unable to determine” also indicates there will be no further specificity for the type of pneumonia.

Question:  Can you further specify the organism responsible for pneumonia?

*Bacterial pneumonia (specify organism____________)
*Viral pneumonia (specify organism ____________)
*Other (specify _______________)
*Unable to determine