This webinar focuses on correct ICD-10-CM coding and critical thinking when selecting a principal diagnosis for inpatient admission in a hospital. The presenters explain how to use the ICD-10-CM Official Coding Guidelines when selecting a principal diagnosis.

Think Critically When Identifying and Selecting the Principal Diagnosis for Inpatient Admissions

This webinar is co-presented with Crysta Dickens, RN, CIC, and it focuses on correct coding and critical thinking when selecting a principal diagnosis for inpatient admission during hospitalization. The presenters walk you through the ICD-10-CM Official Coding Guidelines for Coding and Reporting FY 2023, Section II. Selection of Principal Diagnosis.

Section II includes guidelines for selecting the principal diagnosis for non-outpatient settings, which makes references to other sections and chapters of the ICD-10-CM Official Coding Guidelines. This webinar discusses the relevance of these sections for principal diagnosis selection. Another focus of this presentation is explaining the definition of principal diagnosis by walking through the meaning of each point in the definition. It will explain key reference terms to pay attention to when coding, such as “and,” “with,” “see,” “see also,” “code also,” “Excludes 1 and 2 notes,” “code first,” “use additional code,” and “in diseases classified elsewhere.”

The presenters emphasize the difference between “principal diagnosis” vs. other terms such as “admitting diagnosis,” “discharge diagnosis,” and “primary diagnosis.” By the end of this webinar, you will understand why it’s important to analyze physician documentation and understand guidelines when sequencing the principal diagnosis because it can significantly impact reimbursement for healthcare services.

Learning Objectives/Agenda

• A better understanding of exactly what defines principal diagnosis

• How to correctly apply ICD-10-CM guidelines and critical thinking in selecting the chief reason for an inpatient admission

• The distinction between “code first” and “code as principal diagnosis.” These carry different meanings!

• The meaning of “circumstance of admission,” condition “after study,” and “occasioning” the admission as it applies to the principal diagnosis.

• The importance of being aware of all coding conventions, sequencing rules, and chapter-specific guidelines.

• When to query a provider about ambiguous, conflicting, and unclear clinical documentation (i.e., POA status, specificity, type, clinical criteria, etc.).

Why is this topic important?

Selecting a principal diagnosis is key to capturing appropriate reimbursement for hospitals and the context of the admission. There are many key points and factors for a coder to consider before selecting a principal diagnosis to ensure the best selection for the chief reason for an admission. Reporting the principal diagnosis correctly helps to portray an accurate representation of a patient’s hospital stay and fortifies healthcare payment, fulfills quality measures, ensures better statistical reporting of clinical data, and adheres to compliance with rules and regulations.

Who would benefit from this topic?

• Inpatient coders and billers
• Inpatient auditors
• Inpatient providers
• Hospital staff
• Medical coding auditors
• Facility medical coders

What’s the presenter's background/expertise on this topic?

Cala has a total of 10 years of experience in inpatient and outpatient coding and 30 years of experience in nursing in the inpatient and outpatient settings. Her earliest coding experience included hospital and ambulatory surgery billing and reimbursement. Cala has worked for the last eight years in both professional (CPT®) and facility diagnosis-related group (DRG) coding in leadership roles such as mentoring, education, and training, as well as in hospital reimbursement recovery resolution and auditing. Her broad clinical nursing background has been an asset to this role. Cala has applied her nursing and clinical knowledge to a deeper understanding of coding, particularly as it applies to inpatient hospitalizations. Her key focus is education for all stakeholders.

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