This page addresses follow-up questions and additional information pertinent to our webinar
Principles of Principal Diagnosis Selection.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: When selecting the principal diagnosis, queries to the physician may play a big role in determination. Is there a limit to when we can query for principal diagnosis.
A: There is no required timeframe as to when a provider must identify a condition or document a condition to be present on admission. In some clinical situations, it may not be possible for a provider to make a definitive diagnosis for a period of time after admission. This does not mean the condition was not the principal diagnosis or present on admission.
Q: When trying to choose the principal diagnosis, and there are multiple conditions that meet the definition, how do you know which to choose as the principal diagnosis if all factors were equal?
A: Per CMS, the IPPS final rule states they do not believe there is anything inappropriate, unethical or otherwise wrong with hospitals taking full advantage of coding opportunities to maximize Medicare payment, as long as the coding is fully and properly supported by documentation in the medical record. In addition, AHIMA’s Standards of Ethical Coding instruct to select and sequence the codes such that the organization receives the optimal reimbursement to which the facility is legally entitled, remembering that it is unethical and illegal to increase reimbursement by means that contradict requirements.
Q: Is there any difference in the guidelines for reporting principal diagnosis for an obstetric patient, vs any other patient?
A: In general, the basics of assigning the principal diagnosis for obstetric patients is the same. However ,the obstetrics chapter of Section I of the Official Coding Guidelines specifies that codes from chapter 15 (Pregnancy, CChildbirth, and the Puerperium) have sequencing priority. The principal diagnosis for an obstetric patient will ALWAYS be an O code.
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Tommi Mooney, MS, RHIA, CCS
Senior Coding Quality Auditor
Tommi brings ten years of experience in coding and auditing to the team as a Senior Coding Quality Auditor. Her career began as a Hospital Coding Specialist, where she quickly advanced through various roles, ultimately becoming the Director of Coding over Internal Audits and Education. In each of these positions, Tommi honed her skills in coding, auditing, and compliance. Throughout her career, Tommi has overseen internal audits, developed educational resources for coding professionals, and provided guidance to ensure coding accuracy and compliance across departments. Her leadership and dedication to improving coding quality have made her a key contributor to the team, where she provides audit oversight and coding expertise to support clients.
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