Other Ordering Issues
Another International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) rule is that the first diagnosis listed is the "condition that occasioned the admission of the patient to the hospital" or was the “focus of the outpatient visit.” When using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) in mental health treatment settings, presumably it is the psychiatric rather than medical condition that was the reason for visit or admission to the hospital, so ordinarily there would not be a problem. However, psychiatrists practicing in general medical settings like primary care clinics or consultation-liaison settings (i.e., who are treating the psychiatric sequalae of a medical condition) should list the medical condition first. This problem is less likely to be detected by software since the computer would have no way of knowing whether the principal diagnosis is a psychiatric or general medical condition. (i.e., this differs from the prior situation in which the codes themselves dictate the expected order).