What is the Definition of Primary Diagnosis?

The term “Primary Diagnosis” was commonly used before in order to describe the condition of a patient receiving outpatient health care. It has since been considered outdated. Now, the more appropriate term used is “First-listed Diagnosis”. Both these have a similar definition. They pertain to the condition which is currently being investigated or treatment in ambulatory or outpatient care. In cases where no specific diagnosis has been made, the main symptom, problem or abnormality can serve as the first-listed diagnosis. Doctor’s clinics, outpatient hospitals and ambulatory centers are able to determine the said diagnosis. It must be noted that for inpatient settings, “Primary Diagnosis” is still the prevailing term to be used when referring to the most serious condition upon hospitalization.

Do not confuse “Principal Diagnosis” with “Primary Diagnosis”. They can both be used when discussing inpatient care however, they denote different things. Primary diagnosis (PDX) refers to the most resource intensive condition when an individual gets hospitalized. “Principal Diagnosis” can only be determined after carefully examining a patient. Emphasis is given to the word “after”. PDX can only be established after a study that ascertains the main cause for the condition of the person. This would even include the review of all of the patient’s documents containing his or her medical history. There must be a well-defined clinical condition which serves as the reason for the necessity of admission of the patient. This will be provided by the principal diagnosis.

Let’s give a specific example. A person complaining of a chest pain might be suffering from a heart condition or pneumonia. The symptom of the chest pain can be the primary diagnosis if the patient is admitted to the hospital. On the other hand, giving a principal diagnosis will only come after the specific cause is established after a careful study. It could only be one of the two, either pneumonia or a heart attack. Before a patient gets discharged, there must already be a clear PDX.

Here is another sample of how to differentiate these two medical terms which are used in patient coding. Let’s state the example of a patient that was operated for a gallbladder disease. After, the operation he suffers from a heart attack. In this case, the gallbladder disease is determined as the principal diagnosis; since it was the main reason why the patient was brought to the hospital, in the first place. The incident of the heart attack qualifies as the primary condition. Based on the aforementioned definition, this condition involves more resources and services from the hospital. Examinations, medicines, consultations and other procedures will be used in researching how to assess and treat the disease.

Most health care providers use the principal diagnosis, together with secondary conditions that are relevant to patient care during confinement and related surgeries, in order to create the Diagnosis Related Group (DRG). Proper reporting from the group helps establish proper payment through reimbursements. The principal diagnosis is vital to the assignment of the correct DRG.