Assigning the correct principal diagnosis is one of the most critical — and most misunderstood — steps in the inpatient coding process. Despite clear conventions and guidelines, subjectivity often creeps in, creating risk. The chosen principal diagnosis not only drives MS-DRG assignment and reimbursement but also determines inclusion in CMS quality measures tied to readmission and mortality rates. When coding decisions don’t align with the clinical reality, hospitals face increased vulnerability to both medical necessity and DRG denials — and potential financial penalties.

Join Cheryl Ericson, RN, MS, CCDS, CDIP, a recognized leader in the clinical revenue cycle, for an in-depth exploration of principal diagnosis assignment through both coding and clinical lenses. This session unpacks common misconceptions that lead to denials and examines real-world data from Comprehensive Error Rate Testing (CERT). Attendees will learn how to apply coding guidelines more accurately, consider medical necessity in sequencing decisions, and strengthen documentation practices that support compliant billing and accurate quality reporting.

Why This is Relevant:

Even experienced professionals can struggle with the nuances of principal diagnosis assignment. This session provides the critical thinking tools needed to ensure each principal diagnosis accurately reflects the clinical scenario, supporting compliant billing, defensible coding, and stronger data integrity across reimbursement and quality programs — all while reducing vulnerability to denials.

Learning Objectives:

At the completion of this webinar, attendees will be able to:

• Explain the concept of medical necessity and its role in coding decisions
• Examine when documentation of “due to” should influence principal diagnosis assignment
• Discuss coding guidelines for the principal diagnosis and debunk common myths
• Identify principal diagnoses tied to CMS quality measures and their intent
• List MS-DRGs vulnerable to denial, as identified by Medicare’s Comprehensive Error Rate Testing (CERT)

Who Should Attend:

CDI professionals, Coders, Physician Advisors, Denials Management, Utilization Review staff, Quality professionals.