Secondary diagnoses describe conditions that co-exist at the time of admission, or that develop later, and that affect the patient's care for the patient. A secondary diagnosis refers to a co-existing condition that could exist at the time the patient is admitted. This condition may evolve over the course of the patient's stay or may be a reason for additional treatment. Like the primary diagnosis, secondary diagnoses are a key component of medical claims and provider billing.
Both the primary and secondary diagnoses are used for medical billing purposes. The primary diagnosis is the condition that requires the most resources from the provider during the patient's stay or is the primary reason for the patient's visit. A secondary diagnosis is a co-existing condition that exists during the same visit. Some examples of a secondary diagnosis would be a patient with diabetes who is admitted for heart failure or a patient with high blood pressure who is admitted to the hospital for pneumonia.
In both cases, the reason for admission (i.e., the distinction between the primary and secondary diagnosis in medical coding and billing) plays a vital role in determining the correct codes and ensuring accurate reimbursement. Primary diagnosis is the primary reason a patient seeks medical attention, while secondary diagnoses refer to other conditions that are present but are not the primary reason for the visit or admission.
