Secondary Diagnosis

What is a secondary diagnosis?

A secondary diagnosis refers to a coexisting condition that might exist at the time of patient admission. This condition might evolve over the course of the patient’s stay, or it might be cause for further treatment. Like primary diagnosis, secondary diagnoses are a key component of medical claims and provider billing.

What is the difference between primary and secondary diagnosis?

Both primary and secondary diagnoses are used for medical billing purposes. Primary diagnosis is the condition that demands the most provider resources during the patient’s stay or is the main reason for their visit. A secondary diagnosis is a coexisting condition that exists during the same visit.

What is an example of a secondary diagnosis?

Examples of a secondary diagnosis would include a patient having diabetes but being admitted for heart failure or a patient having high blood pressure being admitted to the hospital for pneumonia. In both of these scenarios, the reason for being admitted (i.e., heart failure and pneumonia) would be the primary diagnosis, and the coexisting conditions (i.e., diabetes and low blood pressure) would be the secondary diagnosis.

Why is a secondary diagnosis important in healthcare?

Secondary diagnoses are paired with corresponding billing code sets (e.g., ICD-10 or DRG) and sent to healthcare payors in the form of a medical claim. This process is how healthcare providers receive reimbursement for healthcare services.