Cracking the Code

Principal Diagnosis Guidelines – Two Interrelated Conditions

Direct guidance from the coding guidelines state that either condition may be sequenced first when two or more interrelated conditions potentially meet the definition of principal diagnosis. The interrelated conditions refer to diseases in the same ICD-10-CM chapter or manifestations characteristically associated with a certain disease. The ONLY exception to this rule is when the circumstances of the admission, the therapy provided, the Tabular List, or the Alphabetic Index indicate otherwise. If there are no chapter-specific guidelines or instructional notes under the code description for sequencing, then either condition can be listed as the primary diagnosis.

Q: A 63-year-old female with a past medical history significant for congestive heart failure with EF of 35-40%, severe aortic stenosis status post TAVR, cardiac arrest post AICD implantation, type 2 diabetes, is admitted for pre-syncope and hypotension. Hypotension – secondary to diuretic use, decreased oral intake, and daughter reported possible laxative abuse to the ED provider. Per discharge summary, patient has a final diagnosis of hypotension-hypovolemia due to poor PO intake and diuretic use.
A: Per coding guideline section II.B., either the hypotension or the hypovolemia can be sequenced as the primary diagnosis.
I95.9, hypotension, unspecified
Reference: ICD-10-CM Official Guidelines for Coding and Reporting Section II.B. Two or more interrelated conditions, each potentially meeting the definition for principal diagnosis.
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