Selecting the Principal Diagnosis Lies at the Heart of Inpatient Coding

by  Gloryanne Bryant, RHIA CDIP CCS CCDS AHIMA-Approved ICD-10-CM/PCS Trainer
Mar 9th, 2022

The heart of the principal diagnosis selection is pivotal to accuracy and compliance.

Since February is known as “National Heart Month,” a discussion on the heart of inpatient coding is appropriate, that being the “principal diagnosis.” When learning inpatient coding, a large amount of time is spent on understanding the guidelines, conventions, and application of this term.

Within the four sections of the Official Guidelines for Coding and Reporting, we find the following:

• Section I: Conventions, General Guidelines, and Chapter-Specific Guidelines;
• Section II: Selection of the Principal Diagnosis;
• Section III: Reporting Additional Diagnoses (often referred to as the guideline for the inpatient selection of “secondary diagnoses;” and
• Section IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services.

The guidelines for “Selection of the Principal Diagnosis” includes the following, which must be read over carefully and frequently:

A. Codes for symptoms, signs, and ill-defined conditions;

B. Two or more interrelated conditions, each potentially meeting the definition for principal diagnosis;

C. Two or more diagnoses that equally meet the definition for principal diagnosis;