Guide About Primary and Secondary Diagnosis

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Secondary Diagnosis

Introduction

There is a great importance of primary and secondary diagnosis in the medical field. Primary diagnosis can be defined as a condition responsible for occasioning the patient’s admission to the hospital for getting healthcare services. It majorly represents the reason for the stay of the patient at the hospital or any other healthcare center.

Similarly, secondary diagnosis also plays a vital role as it represents the conditions that coexist at the time of the patient’s admission to the hospital and affects the treatment received or the length of stay. This guide explains the primary diagnosis vs. secondary diagnosis and related information in the medical field. The significant difference between these terms is the difference in the conditions applied according to the rules defined in them.

Primary Diagnosis

A primary medical diagnosis can be defined as a specific condition that is responsible and related to the admission of the patient into a healthcare center or a hospital for care. It represents the reason behind the stay of the patient at the hospital and does not explain how great the length of the patient’s stay was. It also does not explain the most life-threatening condition and most excellent consumption of hospital resources.

Primary diagnosis also explains and reflects the clinical findings that are discovered during the stay of the patient at the hospital or any other healthcare center. It may also differ from admitting diagnosis. Primary diagnosis does not explain why a person is at the hospital and what brought him there.

Example:

A patient is admitted to the hospital due to a fracture in the knee. He is brought to the preoperative holding area for the purpose of the surgery and suffers an ST-segment evaluation myocardial infarction before the start of the surgery. The patient is sent to the Cath Lab for a stent placement instead of the operating room for the replacement of the knee.

In this case, the primary diagnosis is osteoarthritis. Acute STEMI is not the primary diagnosis because it is not the condition that resulted in the admission of the patient to the hospital.

Secondary Diagnosis

Secondary diagnosis can be defined as the conditions that coexist at the time of patient admission and dramatically affect the length of the patient’s stay at the hospital and the treatment received by the patient. This type of diagnosis is vital to documentation and has the potential to impact the patient’s severity of illness.

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Secondary diagnosis is related to the earlier episode where the current inpatient admission is excluded. It can be defined as the patient’s baggage. Thus, it impacts the current episode of patients’ admission to the hospital or any other healthcare center.

Difference Between Primary and Secondary Diagnosis

This section explains primary vs. secondary medical diagnosis where there is a slight difference between these two terms. In medical coding, we can define primary diagnosis as the condition that needs the most care and resources.

On the other hand, secondary diagnosis is the condition that exists when a patient I admitted to the hospital. It involves the stay of the patient at the hospital and further treatment to be provided to the patient. In short, both are considered major components of medical claims and provider billing.

ICD-9-CM Codes

ICD-9-CM can be defined as an official system that is majorly used for assigning the codes for diagnoses and procedures that are related to hospital utilization in the US. This system comprises of:

  • An alphabetical index to the disease entries
  • A classification system for therapeutic, diagnostic, and surgical procedures.
  • A tabular list that contains a numerical list of the disease code numbers in tabular form.

Primary User of ICD Codes

It includes the health care personnel such as nurses and physicians and the medical coders who assign ICD-9-CM codes to verbatim or procedure information or abstracted diagnosis and are considered the originators of the ICD codes. There are several purposes of using ICD-9-CM codes, including claim reimbursements, billing, and statistics.

Secondary Users of ICD Codes

It includes those people who use already coded data from the health plans, health care providers, or hospitals for conducting surveillance or research activities. The major secondary user of coded data is public health. These users let you understand the concept of primary diagnosis vs. secondary diagnosis.

Difference Between ICD-9-CM Codes and ICD-10/PCS Code Sets

Following are some of the common differences among the code set of ICD-10/PCS and ICD-9-CM codes:

  • The diagnosis codes in ICD-10-CM are five times more than that in ICD-9-CM.
  • ICD-10 consists of alphanumeric categories, while ICD-9-CM consists of numeric ones.
  • The orders of chapters in both code sets are also changed
  • There is a difference between the titles of the diagnosis codes
  • The conditions in ICD-10 and ICD-9 are also grouped differently
  • The procedure codes in ICD-10-PCS are nineteen times different as compared to that of ICD-9-CM volume 3
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Principal Diagnosis Code

It is a type of diagnosis code that helps identify the diagnosis, problem, condition, and many other related reasons for the visit/encounter/admission shown in the medical record responsible for the services provided to the patient.

Principal Procedure Code

It is related to the procedures that are performed for providing definite treatment to the patient instead of performing only for exploratory or diagnostic purposes. It is surgical in nature and carries an anesthetic risk. The surgery includes manipulation, suture, destruction, repair, endoscopy, introduction, amputation, excision, and incision.

FAQs

  • What do you know about primary vs. secondary diagnosis?

Primary diagnosis is responsible for occasioning the patient’s admission in the hospital for providing health care, whereas secondary diagnosis co-exists with the admission time that develops subsequently, affecting the received treatment and the stay length.

  • The diagnosis for CAD, COPD, and DM is included in which type of diagnosis? State the reason.

The diagnosis for CAD, COPD, and DM is included in secondary diagnoses because the diagnosis for these diseases requires monitoring and treatment during the stay of the patient at the hospital.

  • What is the importance of secondary diagnosis in healthcare?

In healthcare, secondary diagnosis plays a vital role because it is paired with the corresponding billing code sets such as DRG or ICD-10. It is then sent to the healthcare payers as a medical claim. This is the process through which the providers receive reimbursement for the healthcare services.

  • What is the importance of ICD-9 CM codes in the medical field?

There is a great importance of ICD-9 CM codes in the medical sector because these codes are assigned to the patients because they are recorded and used for mortality and morbidity statistics, automatic decision support, and reimbursement systems in medicine. You should keep in mind that incorrect diagnosis can result in affecting the medical coverage of a patient.

  • What is required by a condition to be considered a secondary diagnosis?

The condition must require increased nursing care, an extended length of stay, diagnostic studies, therapeutic treatment, and clinical evaluation to be considered a secondary diagnosis.

Conclusion

You may have some indication about primary diagnosis vs. secondary diagnosis in the medical sector, where they both play a vital role in medical billing. The ICD-9 CM codes let you diagnose the right disease and charge the patient accordingly. 

So, it is necessary to have knowledge about these codes. These codes are helpful in classifying diseases, inpatient procedures, health encounters, and injuries.

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