Code the existing underlying conditions when an impending condition hasn’t occurred by discharge

When you’re staring at a discharge summary, and the physician notes an impending condition that didn’t actually occur, what do you code? A lot of coders stumble here, because the wording feels precarious. The right move, grounded in ICD-10-CM guidelines, is to code the existing underlying conditions—not the impending one that never materialized.

Let me explain how this works in the real world of medical records and billing.

The core rule: code what’s clinically supported at discharge

Imagine you’re cleaning up a chart after a patient leaves the hospital. The discharge diagnoses should reflect the patient’s true status at the moment of discharge: what the patient actually had, what was treated, and what’s still relevant to care. If a physician writes “impending condition” but that condition never happened by discharge, it hasn’t become a documented, confirmed diagnosis. In that case, you don’t code it. The emphasis is on conditions that are clinically demonstrated and meet the criteria for specificity.

Why not code the impending condition?

There’s a simple reason behind the rule: billing and medical records should mirror reality, not guesses or near-misses. If you code an impending condition that didn’t occur, you aren’t aligning with the documentation or the patient’s actual clinical status. That can lead to inaccuracies in the record, questionable billing practices, and potentially audits or denials down the line. It’s not about being stingy with diagnoses; it’s about staying faithful to what was actually present and treated.

So, what should you code instead?

Code the existing underlying conditions that were present and that influenced the care provided. These are the problems that clinicians documented as diagnoses during the encounter and that meet the coding guidelines for specificity. For example, if a patient is admitted with multiple chronic issues and an “impending infection” line appears but never becomes an active infection, you would still code the chronic conditions that affected management (like diabetes, hypertension, chronic kidney disease, COPD, etc.), provided they were active and clinically relevant during the stay.

A practical walkthrough you can use

Let’s walk through two common scenarios. This helps translate the rule into everyday chartwork.

Scenario 1: Impending pneumonia noted, but no pneumonia by discharge

• The physician writes: “impending pneumonia,” but imaging and labs never confirm pneumonia by discharge.

• What you code: The patient’s active, underlying conditions (for example, COPD, diabetes, heart disease) that influenced care and were treated during the stay. If the chart shows bronchitis or a stable resp status without pneumonia, you’d code what’s actually present and documented as diagnosed.

• Why this approach is sound: It stays anchored to documentation that supports a specific diagnosis and aligns with the principle that codes reflect the patient’s status at discharge.

Scenario 2: Impending stroke noted, then no cerebrovascular event

• The physician notes “impending stroke risk” or “possible impending stroke,” but no stroke occurs.

• What you code: Any active conditions that were treated or managed and are documented as diagnoses (for example, hypertension, atrial fibrillation, vascular disease, or diabetes that affects the care plan).

• Why this approach is sound: You aren’t coding the risk or possibility; you’re coding the conditions that actually exist and were clinically relevant on discharge.

A quick note about documentation language

Sometimes, clinicians use phrases like “impending” or “possible,” which can feel risky to coders. The key is to look for what is confirmed in the chart. If the discharge diagnoses list shows a confirmed condition, you code that. If not, you focus on the conditions that are clearly documented as present. If something is uncertain, seek clarification or, at minimum, avoid coding it as if it were a definite diagnosis.

What about “waiting for further documentation”?

Sure, it’s reasonable to want complete clarity, especially when claims are on a tight timeline. But you can’t code something that isn’t documented as occurring. Waiting for more documentation to code an impending condition isn’t a practical shortcut; it’s better to code what’s actually documented and ensure the chart is clear about any pending issues in a way that doesn’t misrepresent the patient’s status at discharge.

A few tips for steady, compliant coding

• Focus on discharge diagnoses: Keep your codes tied to what the chart shows as diagnosed and active at discharge.

• Distinguish comorbidities from primary problems: Comorbidities are other conditions that affect care; principal diagnosis is the main reason for admission. Both should be supported by documentation.

• If a condition is “suspected” or “ruled out,” don’t code it as a confirmed diagnosis unless the physician documents it as such. If the chart shows a “rule-out” status, you may code signs or symptoms only if they are clinically relevant and documented as such, not the suspected disease itself.

• Review the documentation for clarity: If a clinician intends to capture a risk rather than a diagnosed event, note that in the chart. This helps future readers and coders understand the clinical reasoning without inflating the coded diagnoses.

• Use authoritative resources: Official ICD-10-CM guidelines, CMS/Medicare instructions, and Coding Clinic guidance are your north star. They’re there to keep interpretation consistent across facilities.

• Don’t code to please the payer. Accuracy and completeness beat “covering” a billing scenario. When in doubt, ask for clarification or flag the note for review.

A note on real-world nuance

Medical records aren’t always perfectly clean. Some charts contain a tangle of terms, shorthand, and evolving status. The most reliable path is to code only what’s documented as present and diagnosed. If an impairment or risk factors are important to the patient’s care and outcomes, they should be documented clearly as ongoing conditions, not as unverified suspects. That clarity is what makes the chart trustworthy for clinicians, researchers, payers, and patients.

Why this matters beyond the ledger

You might wonder, “Isn’t coding all the possible conditions fair, since it captures the patient’s full health picture?” It’s tempting, but not practical or accurate. The aim is precise communication: a medical record that accurately reflects the patient’s actual diagnoses at discharge. When underlying conditions drive the care plan, they deserve to be documented and coded—while speculative or non-occurring items do not belong in the coded record.

A friendly reminder: the big picture

Coding isn’t a single-step chore; it’s a careful dialogue between what the chart shows and what the guidelines require. The rule about not coding an impending condition that hasn’t occurred is part of a broader commitment: codes should be specific, supported, and meaningful for treatment, billing, and data quality. By sticking to what’s actually documented, you help ensure clean, defensible records and smoother processing for everyone involved.

A final thought you can carry forward

The moment you see “impending” in a discharge note, pause and verify: Did this condition occur? If not, what is truly documented as present? Code those conditions that meet the bar for specificity and clinical support. It’s a small decision, but it has a big ripple effect—on patient care continuity, on the clarity of the medical record, and on the integrity of the coding you do every day.

If you’re navigating discharge summaries, you’re not alone. This kind of attention to detail is exactly what keeps records precise and claims accurate. And when you can explain a coding choice with confidence, you’re not just penciling in numbers—you’re helping tell a patient’s health story with honesty and care.

Resources you can turn to when you’re unsure

• Official Guidelines for ICD-10-CM Coding and Reporting

• Coding Clinic: Practical guidance from the experts

• CMS guidance and payer-specific policies for billing and documentation

• Internally, at your facility, a quick consult with a clinical documentation specialist can shed light on ambiguous notes

Bottom line

If a physician notes an impending condition that doesn’t manifest by discharge, code the existing underlying conditions that were actually documented and clinically relevant. That’s the path to accurate, defendable documentation and clean claims. It’s a straightforward rule, but one that makes a real difference in the clarity and usefulness of medical records.