Q:
When completing an MDS, how do we know which diagnosis should be coded as the primary diagnosis for a resident with multiple conditions (for example, CHF, diabetes, and pressure ulcer)?
A:
This question comes up often in SNFs. The primary diagnosis should be the condition that is actively being treated and has the most impact on the resident’s care plan during the assessment period. It’s not always the resident’s “most serious” condition overall, but rather the one that requires the most resources, treatment, or monitoring at that time. Correct sequencing is critical, since it directly impacts reimbursement, quality measures, and care planning.
Still not sure if you’re coding correctly?
Join us September 25, 2025 for the Virtual SNF ICD-10 Coding Refresher Workshop. We’ll cover common pitfalls like primary vs. secondary diagnoses, walk through real case studies, and provide practical tools to strengthen coding accuracy to ensure your coding tells the right story for your residents—and your reimbursement.
Written By:
Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CPC, CLNC
Director of Regulatory Services
Proactive LTC Consulting
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