In ICD-10-CM inpatient coding, the principal diagnosis is defined as:
- AWhichever diagnosis is easiest to assign a code to
- BAny chronic condition the patient carries
- CThe comorbidity with the highest severity of illness
- DThe condition established after study to be chiefly responsible for occasioning the admissionCorrect
Why: The principal diagnosis is the condition determined, after study, to be chiefly responsible for the admission. In the outpatient setting the parallel concept is the 'first-listed' diagnosis — the reason chiefly responsible for the visit. Accurate sequencing drives reimbursement and data integrity, so this definition is foundational to ICD-10-CM.

