Wiki Principal diagnosis Inpatient hospital stay

jaxdoc

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According to the AAPC manual I used to get my CPC, the Principal or First-listed Diagnosis instructions state (2015 AAPC General Code Set Training p.24): "If no sequencing restrictions apply, then sequencing is based on the condition that brought the patient into the hospital or physician office, and which condition was the primary focus of treatment."

This does not seem to align with Section II of the coding guidelines which references "that condition after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care."

My question is:
1) Is the principal diagnosis the condition that after study we feel caused the patient to be admitted to the hospital? OR
2) Is it the condition that during the hospitalization we feel is really the primary focus of treatment (and the continued stay), even if this was NOT the condition that caused the admission?

Which do you use in practice #1 or #2?
 
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