Section II Selection of Principal Diagnosis
TLDRIn this informative session, Dr. Campbell discusses the intricacies of selecting the principal diagnosis according to ICD-10-CM guidelines, emphasizing the importance of the inpatient admission circumstances. The session covers various scenarios, including handling signs and symptoms, interrelated conditions, and uncertain diagnoses, as well as special considerations for observation, outpatient surgery, and rehab admissions. Dr. Campbell's insights ensure a clear understanding of coding practices that accurately reflect the reasons for patient admissions and the care provided.
Takeaways
- 📌 The principal diagnosis is determined by the circumstances of the inpatient admission and is chiefly responsible for the admission.
- 📌 The Uniform Hospital Discharge Data Set defines the principal diagnosis as the condition established after study.
- 📌 Coding conventions in section one and the tabular list/alphabetical index take precedence over other guidelines.
- 📌 Signs and symptoms should not be used as a principal diagnosis when a definitive diagnosis has been established.
- 📌 In cases of interrelated conditions, either condition may be sequenced first unless specified otherwise by the guidelines.
- 📌 When two or more diagnoses equally meet the definition, either may be sequenced first based on admission circumstances.
- 📌 Comparative or contrasting diagnoses are coded as if confirmed, and the sequence depends on the admission circumstances.
- 📌 If the original treatment plan is not carried out, the reason for the surgery or procedure is sequenced first.
- 📌 Complications of surgery or other medical care are sequenced as the principal diagnosis, with additional codes if necessary.
- 📌 Uncertain diagnoses are coded as if they existed or were established, based on the diagnostic workup and initial therapeutic approach.
- 📌 Observation status admissions are sequenced based on whether the condition worsens or improves, or if a post-op complication develops.
- 📌 Outpatient surgery admissions are sequenced based on complications, the surgery itself, or an unrelated condition if admitted for a different reason.
- 📌 For rehab admissions, the code for the condition for which the service is performed is sequenced first, followed by appropriate aftercare codes if applicable.
Q & A
What is the main focus of section two of the ICD-10-CM guidelines?
-The main focus of section two of the ICD-10-CM guidelines is the selection of the principal diagnosis.
How is the principal diagnosis defined according to the Uniform Hospital Discharge Data Set?
-The Uniform Hospital Discharge Data Set defines the principal diagnosis as the condition that, after study, is chiefly responsible for the admission of the patient to the hospital for care.
What should be considered when the circumstances of the inpatient admission are involved in the selection of the principal diagnosis?
-The circumstances of the inpatient admission will always govern the selection of the principal diagnosis, taking precedence over other guidelines.
What is the rule for coding signs and symptoms as a principal diagnosis?
-Signs and symptoms should not be used as a principal diagnosis when a related definitive diagnosis has been established.
How should interrelated conditions be handled when selecting the principal diagnosis?
-When two or more interrelated conditions meet the definition of a principal diagnosis, either condition may be sequenced first, unless the circumstances of the admission or the tabular list or alphabetical index indicate otherwise.
What should be done when two or more diagnoses equally meet the definition for principal diagnosis?
-In such cases, either of these diagnoses may be sequenced first, and one should also consider the alphabetical index or tabular list for any other options.
How are situations with two or more comparative or contrasting diagnoses coded?
-They are coded as if they are confirmed, and the diagnosis is sequenced according to the circumstances of the admission.
What is the coding guideline when the original treatment plan is not carried out?
-The reason for the surgery or treatment that was intended is sequenced first, and a Z code can indicate that the procedure was not done due to specific circumstances.
How should uncertain diagnoses be handled at the time of discharge?
-Uncertain diagnoses should be coded as if they existed or were established, based on the diagnostic workup and initial therapeutic approach that corresponds most closely with an established diagnosis.
What is the guideline for coding when a patient is admitted for observation and then converted to inpatient status?
-The principal diagnosis would be the medical condition that led to the hospital admission, whether it was for observation or subsequent inpatient care.
How are admissions for rehabilitation coded in terms of the principal diagnosis?
-The code for the condition for which the service is being performed is sequenced first. If the condition is no longer present, the appropriate aftercare codes are reported as the first listed or principal.
Outlines
📚 Selection of Principal Diagnosis in ICD-10-CM Guidelines
This paragraph discusses the selection of the principal diagnosis according to ICD-10-CM guidelines, emphasizing that the circumstances of inpatient admission govern this selection. It explains that the principal diagnosis is the condition chiefly responsible for the admission, as defined by the Uniform Hospital Discharge Data Set. The paragraph highlights the importance of coding conventions from section one and the tabular list and alphabetical index over these guidelines. It also outlines various scenarios for selecting the principal diagnosis, including situations with signs and symptoms, interrelated conditions, multiple diagnoses meeting the definition, comparative or contrasting diagnoses, and original treatment plans not carried out. Additionally, it addresses complications of surgery and other medical care, as well as the handling of uncertain diagnoses.
🏥 Observation Admissions and Outpatient Surgery
The second paragraph delves into the specifics of handling observations from an admission unit and outpatient surgeries. It explains the guidelines for when a patient's condition worsens or does not improve after being admitted for observation, leading to inpatient status for the same condition. The principal diagnosis in such cases is the medical condition leading to the initial hospital admission. The paragraph also covers post-operative observations and the application of the principal diagnosis definition. For outpatient surgeries followed by inpatient care, it outlines the considerations for coding the principal diagnosis based on complications, the reason for surgery, or unrelated conditions. Lastly, it discusses admissions and encounters for rehabilitation purposes, emphasizing the need to sequence the code for the condition for which the service is performed.
Mindmap
Keywords
💡ICD-10-CM
💡Principal Diagnosis
💡Uniform Hospital Discharge Data Set (UHDDS)
💡Coding Conventions
💡Interrelated Conditions
💡Complications of Surgery
💡Uncertain Diagnosis
💡Observation Status
💡Rehabilitation
💡Outpatient Surgery
Highlights
The principal diagnosis is determined by the circumstances of the inpatient admission.
The Uniform Hospital Discharge Data Set defines the principal diagnosis as the condition chiefly responsible for the patient's admission.
Coding conventions in section one of the guidelines and the tabular list and alphabetical index take precedence over other guidelines.
Signs and symptoms should not be used as a principal diagnosis when a definitive diagnosis has been established.
In cases of interrelated conditions, either condition may be sequenced first unless specified otherwise by the tabular list or alphabetical index.
When two or more diagnoses equally meet the definition for principal diagnosis, either may be sequenced first.
Comparative or contrasting diagnoses are coded as if confirmed, and the sequence of diagnosis is determined by the circumstances of admission.
If the original treatment plan is not carried out, the reason for the surgery or treatment is sequenced first.
A status code (Z code) can indicate a procedure not done due to specific circumstances.
For admissions treating complications from surgery or other medical care, the complication code is sequenced as the principal diagnosis.
Uncertain diagnoses are coded as if they existed or were established, based on the diagnostic workup and initial therapeutic approach.
The guideline for uncertain diagnoses only applies to inpatient admissions to short-term acute, long-term care, and psychiatric hospitals.
When a patient in observation worsens or does not improve and is converted to inpatient status, the principal diagnosis is the medical condition leading to admission.
For observation following outpatient surgery, the principal diagnosis is determined by the condition established after study to be chiefly responsible for admission.
In outpatient surgery followed by inpatient admission for the same hospital, the principal diagnosis depends on the reason for admission: complication, outpatient surgery condition, or an unrelated condition.
For admissions and encounters for rehab, the code for the condition for which the service is being performed is sequenced first.
Rehab services following active treatment of an injury assign the injury code with the appropriate 7th character to identify it as a subsequent encounter.
The purpose of coding is to paint a picture of the care provided and inform the insurance company why the patient was admitted.
Transcripts
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