Q&A Psych Coding

[sadubose]

Need guidance:

Example 1
Primary Admitting Diagnosis = F31.2 (Bipolar disorder, current episode, manic severe with psychotic features)
Primary Discharge Diagnosis = F31.73 (Bipolar disorder, in partial remission, most recent episode manic)

Example 2
Primary Admitting Diagnosis = F33.1 (Major depressive disorder, recurrent, moderate)
Primary Discharge Diagnosis = F33.42 (Major depressive disorder, recurrent, in full remission)

Example 3
Primary Admitting Diagnosis = F10.220 (Alcohol dependence with intoxication, uncomplicated)
Primary Discharge Diagnosis = F10.21 (Alcohol dependence, in remission)

In the above examples, the physician is trying to show (through a diagnosis) that the patient has improved during their hospitalization. The physician also narrates in the Course Summary section of the Discharge Summary the patient's improvement.

My questions:
1. In any of the examples above, what is the true primary/principle/first-listed diagnosis? In the examples, the admitting diagnosis shows the true state of the patient when they arrived/reason why they needed psychiatric hospitalization with the discharge diagnosis showing how the patient presents on the day of discharge.
2. In the above examples, if the true primary/principle/first-list diagnosis is the Primary Discharge Diagnosis, it shows the patient at a "manageable" level so how does that affect the reimbursement side? Is reimbursement lower with this diagnosis?

Any guidance would be greatly appreciated. Thanks!

 

[Jo-Anne Sheehan CPC-I]

I would use the primary diagnosis at admission and continue to use it for subsequent hospital visits until the doctor establishes the patient is now in remission. I always ask myself- why was the patient admitted?
This does not affect your reimbursement. It represents accurate documentation of the patient's condition.