Chapter 3 - Uniform Hospital Discharge Data Set

Question 1

expected payer

Answer 1

the single major source expected by the patient to pay for the bill (e.g. Medicare, Medicaid, health insurance plan)

Question 2

principal diagnosis vs “other diagnosis”

Answer 2

principal diagnosis: the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care

“other diagnosis”: a condition that coexists with the principal diagnosis at the time of admission, or that develops subsequently, or that affect the treatment received or the length of stay; however, it IS NOT an earlier diagnosis that has no bearing on the current hospital stay

Question 3

comorbidity

Answer 3

a disease or medical condition that is simultaneously present with another or others in a patient

Question 4

significant procedure

Answer 4

a procedure that is surgical in nature, carries a procedural or anesthetic risk, or that requires specialized training

Question 5

principal procedure

Answer 5

the procedure performed for definitive treatment rather than for diagnostic or exploratory purposes, or that is necessary to take care of a complication

note: if two procedures appear to be principal, the one most related to the principal diagnosis should be selected as the principal procedure