II.J

Admission from Outpatient Surgery

When a patient receives surgery in the hospital's outpatient surgery department and is subsequently admitted for continuing inpatient care at the same hospital, the following guidelines should be followed in selecting the principal diagnosis for the inpatient admission: • If the reason for the inpatient admission is a complication, assign the complication as the principal diagnosis. • If no complication, or other condition, is documented as the reason for the inpatient admission, assign the reason for the outpatient surgery as the principal diagnosis. • If the reason for the inpatient admission is another condition unrelated to the surgery, assign the unrelated condition as the principal diagnosis.

ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026 (effective October 1, 2025). Published by CMS and NCHS. Reproduced for reference — always verify against the official CMS release.