# admit dx vs d/c dx in ER



## lizardw5 (Mar 12, 2014)

Hello Coders,
I confused myself and am in need of some clarification, please.
Coding for ER. My scenario simply states patient admitted to ER for chest pain, rule out MI. After series of tests, the patient was discharged with Atypical chest pain, CAD, HTN, HX of MI, and DM. Because this is not inpatient, my understanding is there would not be a Principal DX (as this is DX chiefly responsible for admission). I think the Primary DX would be the atypical chest pain (more specific than chest pain)
I would code
786.59 Atypical CP
414.01 CAD (no mention of bypass)
401.9 HTN
412 Old MI
250.00
I appreciate any feedback as I am confused why they are asking for Principal and primary and secondary diagnoses.
Elizabeth CPC


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## soprano (Mar 14, 2014)

The title of your post is "admit dx vs d/c dx in ER". Could it be that you are looking for the admit dx? If so, I would code 786.50 (chest pain, unspecified) as  ER admit or CC dx based on what your scenario states.

I agree with your primary and secondary dx for ER discharge codes assignment.

Principal dx is a term typically used for inpatient coding.


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## lizardw5 (Mar 14, 2014)

Hello,
I appreciate your reply.
I am not understanding why the unspecified chest pain would be coded? As place of service is ER, it does not meet requirements for Principal DX (reserved for inpatient). So we can only code Primary dx the atypical chest pain and other dx's. There is no principal dx because patient is not admitted to inpatient facility.
Apologies if I am missing something.


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## soprano (Mar 14, 2014)

Sorry about the confusion. 

I meant that I would code unspecified CP as CC. When patient presents to ER, type of CP is unknown, therefore, assign unspecified. After exam and tests, physician's final dx is atypical CP, therefore your orignal discharge codes are correct.

Hope that helps.


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## lizardw5 (Mar 15, 2014)

That does help, thank you.


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