Wiki Confusing Coding situation

[Keres81]

So Im at my desk this morning doing some more of my coding homework when I came across a situation in my textbook that I don't understand and was hoping some of my fellow coders *albeit i'm still a coder in training* could help me out or perhaps explain it better for me to understand.

Let me first state the guidelines for this particular situation based on Observation Stay

ICD-9-CM oficial guidelines for coding and reporting
SECTION IV.A
2. Observation stay

When a patient is admitted for observation for a medical condition, assign a code for the medical condition as the first listed diagnosis.

Mkay i got that...so far its a go. However the example it gives states this underneath it

OBSERVATION FOR A MEDICAL CONDITION
Example

Patient was admitted for observation due to chest pain. Patient has chronic obstructive pulmonary disease (COPD). After testing, no evidence of cardiac cause was found. Patient was discharged home. Discharge Diagnosis: Noncardiac chest pain.

First Listed Diagnosis: 786.59 Noncardiac chest pain.

Ok. So here is wut I dont understand. Our guidelines CLEARLY state that we must assign the code for the medical condition as the first listed diagnosis. The first listed diagnoisis that this patient has is COPD. So why is it the book listing it as Noncardiac chest pain? I'm racking my brain and I really shouldn't be wasting so much thought into this example but its driving me bonkers! If someone could shed a little light on this I would greatly appreciate it! Ty for any help!

Keres81

 

[reginalane]

Coders generally should not report codes for signs and symptoms once the physician provides or confirms a definitive diagnosis. In this case, as o/p service, a definitive dx of noncardiac chest pain was provided so this is why you would use this one. COPD is not the acute condition so you would report the acute condition; reason for encounter first.

 

[jdyoutsey]

Yes, what reginalane said is true. The primary diagnosis is the reason that the patient came in for services. They came in for the chest pain, but they also have COPD.