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Principal diagnosis for observation converted to inpatient status

Selection of the principal diagnosis is crucial for correct DRG assignment and reporting of the patient’s condition. When a patient is converted from a medical or surgical Observation status to an Inpatient, the principal diagnosis should be the condition that necessitated Inpatient admission. Per ICD-10-CM Official Guidelines for Coding and Reporting FY 2021, the principal diagnosis is defined as “the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.” This diagnosis may be different from the reason for the initial Observation care.

Q: A patient is admitted to Observation status after being evaluated in the ED for chest pain, shortness of breath, and cough. The physician orders a chest x-ray and results show that the patient has right lower lobe pneumonia. Upon these results, the physician decides to convert the patient to Inpatient status to run more in-depth tests and provide extra treatment for the pneumonia.
A: J18.9, pneumonia, unspecified organism
Reference: ICD-10-CM Official Guidelines for Coding and Reporting Section II.I.1. Admission Following Medical Observation
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