Question:

What are the Medicare rules for a situation when two or more diagnoses equally meet the definition for principal diagnosis? For example, we had a patient who was admitted with systolic congestive heart failure exacerbation and aspiration pneumonia. Both are equally worked up (IV antibiotics, speech eval, NPO, IV Lasix, new echo, etc.).

Answer:

In this case, either may be assigned as principal diagnosis. The best choice may be aspiration pneumonia since, in this case, it will have a higher relative weight.


This question was answered in the 2018 edition of  2018 Essentials for Clinical Documentation Integrity. For more hot topics related to our coding services, please view our store, or call us at 1.800.252.1578 ext. 2.

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