Do you have questions only a healthcare consulting expert can answer? LW Consulting, Inc. gives healthcare professionals the opportunity to ask questions that are answered by specialized industry experts. This month we answer the question, “Does a resident admitting ICD 10 code remain #1, even after a resident has been readmitted back into the nursing home after a hospital stay?”
Current long-term care residents who transfer to a hospital to receive treatment for acute conditions, such as pneumonia, and return to the facility for further care of their chronic condition, such as COPD, may continue to receive care for the acute condition if unresolved. The principal diagnosis is the reason for the continued stay, in the nursing facility. A newly diagnosed condition will be listed after the principal diagnosis to reflect new conditions that affect the resident.
Below are the different diagnoses and when they should be used:
- First-Listed diagnosis – The diagnosis that is sequenced first. The terms, principal and primary, are often used interchangeably to define the diagnosis that is sequenced first.
- Principal diagnosis– The condition established after study to be chiefly responsible for the patient’s admission to the hospital. It is always the first-listed diagnosis on the health record and the UB-04 claim form. This direction applies to nursing homes as stated in the guidelines.
- Primary diagnosis – This term is often used to indicate the reason for the continued stay in the long-term care facility. It is also used interchangeably with principal diagnosis.
For information, contact Jennifer Matoushek, Senior Consultant, at 717-213-3130 or email JMatoushek@LW-Consult.com.