In medical coding and billing, the primary condition for which a patient is receiving treatment or care during a hospital stay or outpatient visit.

ICD-10 (International Classification of Diseases, 10th Edition):

A standardized system used globally for coding diseases, conditions, and other health-related issues, providing codes for use in health records and billing.

Secondary Diagnosis:

Additional health conditions, not the primary reason for the patient’s encounter, but which may coexist or affect the patient’s treatment plan.

Coding Guidelines:

Rules and conventions provided by coding systems, such as ICD-10, to ensure consistency and accuracy in assigning diagnostic codes.

Comorbidity:

The presence of two or more health conditions simultaneously in an individual, influencing the complexity of care and treatment.

Principal Procedure:

In addition to the principal diagnosis, the primary surgical or therapeutic procedure performed during a hospital stay or outpatient visit.

Episode of Care:

The period during which a patient receives continuous care for a particular health condition, typically beginning with the admission and ending with the discharge.

Documentation:

The recorded information in a patient’s health record, including symptoms, diagnoses, treatments, and outcomes, crucial for accurate coding.

Risk Adjustment:

A process used in healthcare finance to account for variations in patient complexity and severity when determining reimbursement rates.

Medical Necessity:

The requirement that healthcare services or procedures be consistent with the patient’s diagnosis or condition and deemed necessary for their care.

Severity of Illness (SOI):

A measure reflecting the extent of physiological decompensation or organ system loss of function associated with a patient’s condition.

Hospital Acquired Conditions (HACs):

Conditions that were not present at the time of admission but developed during the hospital stay, potentially affecting reimbursement.