Medical Coding

Category - Coding Guidelines

In an outpatient setting, what is the primary diagnosis?
  1. The reason the patient came in for the visit
  2. The diagnosis code that the doctor lists first
  3. The problem that causes the patient the most pain
  4. The diagnosis that will result in the most reimbursement
Explanation
Answer: A-In an outpatient setting, the primary diagnosis is the reason the patient came in for the visit, and received services on that day. The primary diagnosis will not always be the code that the doctor lists first, as the doctor may not know the coding guidelines. The problem that causes the patient the most pain will only be the primary diagnosis if it is the reason the patient receives services, but not all diagnoses cause pain. Diagnosis codes also do not have any effect on reimbursement, only procedure codes do.
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