A county medical center admits a patient for acute cholecystitis; controlled hypertension is also documented and managed with home medications. After study, acute cholecystitis remains the condition that occasioned admission. Which diagnosis should be principal?
Select an answer to reveal the explanation.
Short Explanation
Principal diagnosis is the main reason the hospital doors opened for this stay—after the workup settles the story. Here that’s acute cholecystitis. Stable hypertension tagging along on home meds doesn’t steal the headline.
Full Explanation
Under UHDDS and ICD-10-CM Official Guidelines, the principal diagnosis is the condition established after study to be chiefly responsible for occasioning the inpatient admission. Acute cholecystitis meets that definition in this scenario. Controlled hypertension may be reported as an additional diagnosis when it meets reporting criteria, but it is not principal merely because it is chronic. Established definitive conditions are preferred over residual symptom coding.