CASE STUDIES
A. Maria Franklin saw Dr. Walden at Walden-Martin Family Medical Clinic on 10/03/20XX for complaints of nausea,
vomiting, and diarrhea. Dr. Walden documented the condition in Ms. Franklin's health record as probable gastro-
enteritis. We learned in Chapter 14, however, that in this scenario, the health insurance professional would code the
nausea, vomiting, and diarrhea but not the gastroenteritis because it is described as probable and is not yet confirmed.
The diagnosis on the CMS-1500 form would be the symptoms rather than probable gastroenteritis. Dr. Walden sub-
sequently admits Maria to the hospital. For inpatient facility billing, coding of signs or symptoms (especially as the
principal diagnosis) is not a routine practice because many payers would not pay for or would question inpatient
admissions coded with signs and symptoms only. What would the health insurance professional use as the principal
diagnosis on the UB-04? Explain your rationale for using this principal diagnosis.