From the Forum: Principal diagnosis and "most invasive" procedures

Q: Our coders often select the principal diagnosis based on how invasive the testing is. For example, a patient comes in with vertigo and hematemesis. For the vertigo, the physician orders a brain CT, IV medications, and an ear, nose, and throat consult. The patient is diagnosed with a perilymphatic fistula. For the hematemesis, the physician orders a gastroenterology (GI) consult, IV medications, serial hemoglobin and hematocrit (H/H), and an esophagogastroduodenoscopy (EGD) (mild gastritis found). The physician stated there was no source found for the bleeding.

The coder selected the hematemesis as the principal diagnosis because an EGD was done and it was the “more invasive” procedure. The CDI specialist selected the perilymphatic fistula because it was a higher DRG and felt both conditions were what occasioned the admission to the hospital. In this kind of case, the procedure does not drive the DRG.

Has anyone else heard of their coders using this thought process? How would you handle this?