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Selecting the Principal Diagnosis

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1) The definition of principal diagnosis is: ““That condition established _________ to be chiefly responsible for occasioning the admission of the patient to the hospital for care.”
2) A 78-year-old woman is admitted with community-acquired pneumonia, acutely decompensated chronic heart failure, and acute hypoxemic respiratory failure. ABG = pH 7.52 / PCO2 32 / PO2 45 / P-F ratio 180 on room air. She is admitted to the ICU for BiPAP on 40% oxygen, respiratory therapy modalities, Lasix 80 mg IV, IV ceftriaxone and Levaquin. Shortly after admission she desaturates requiring intubation and mechanical ventilation for 48 hours. Her heart failure improves promptly and respiratory symptoms slowly improve. She is extubated and discharged three days later on oral antibiotics. What is the principal diagnosis?
3) The selection of the principal diagnosis is determined by the following EXCEPT:
4) Patient is admitted as an inpatient for cholecystitis with a planned cholecystectomy. In pre-op, the patient goes into atrial fibrillation due to acute myocardial infarction. The surgery is cancelled and treatment is focused on the AMI. What is the principal diagnosis?
5) Patient with cirrhosis of the liver is admitted for bleeding esophageal varices. What is the principal diagnosis?
6) Since sepsis is a severe, high-risk diagnosis, it would be always assigned as a principal diagnosis if present on admission.
7) 76-year-old male is admitted to the hospital with severe abdominal pain. An extensive diagnostic workup is done. On hospital day 3, pancreatic cancer is diagnosed in the progress notes. What is the principal diagnosis?
8) An 80-year-old female fell out of bed at home and fractured her hip. On the way to the hospital, she develops substernal chest pain and abnormal EKG changes. While the troponin was normal initially in the ED, three hours later she was diagnosed with a NSTEMI. The patient is admitted as an inpatient, stabilized, and undergoes a hip ORIF on hospital day 3. What is the principal diagnosis?
9) An 80-year-old male is admitted for acute GI bleed, acute blood loss anemia, UTI, dehydration, electrolyte imbalance. Management includes IV NS at 100cc/hr, IV Cipro, blood transfusion, GI consult, and colonoscopy revealed bleeding diverticulum. What is the principal diagnosis?
10) When management is equally directed towards more than one condition and each condition would typically require inpatient care, principal diagnosis coding rules allow any one of the diagnoses to be assigned as principal diagnosis.
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