Can a code from R65.2 for severe sepsis ever be used as a principal diagnosis?

The choice that states severe sepsis coded from R65.2 cannot be used as a principal diagnosis is correct because of the specificity required for coding in the context of severe sepsis. According to coding guidelines, the principal diagnosis is defined as the condition that, after study, is determined to be chiefly responsible for the admission of the patient to the hospital.

In cases of severe sepsis, specific underlying conditions—such as infections—must be identified and documented to ensure accurate coding. Severe sepsis itself is not considered a definitive principal diagnosis; instead, it is typically a complication or a degree of severity associated with an underlying systemic infection that needs to be specified. Therefore, only the underlying condition (like pneumonia, urinary tract infection, etc.) that leads to severe sepsis should be coded as the principal diagnosis while the severe sepsis may be noted as a secondary diagnosis.

The coding guidelines thus emphasize that R65.2 is not appropriate as a principal diagnosis unless accompanied by an underlying cause, as proper diagnostic coding is crucial for the accurate representation of patient conditions and for ensuring appropriate reimbursement and care management.