Who chooses the primary diagnosis at your place?

We are preparing for PDGM and one of the first things we did was work on not having any primary diagnoses that will not be acceptable. Management is now pushing the coders to choose the primary diagnosis ourselves if the clinician chooses one that won't work under PDGM. They also have figured out the diagnoses that pay the most. Our coding manager works at the hospital and wants us to start coding like inpatient coders, where they choose the order of diagnoses in order to optimize reimbursement. So, anyone else having this problem?


  • Hi Laura,

    My name is Megan Herr and I edit Diagnosis Coding Pro. I think what you are saying is really interesting and I would love to pick your brain a bit further to figure out how to best answer this issue perhaps with an article on tips complying with best coding practices heading into PDGM. If you're interested, shoot me an email at mherr@decisionhealth.com. Thanks !

  • Yikes! You need to be coding based on the physician order/F2F and related to your POC. We have never been allowed to code based on highest reimbursement. If the primary diagnosis given by the physician is not allowable under PDGM, the clinician (or the person in your agency responsible for gaining clarification) should reach out to the physician for an acceptable primary diagnosis.

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