Which condition must always be coded first if it is present?

Gangrene must always be coded first if it is present, as it is a life-threatening condition that indicates severe tissue necrosis, typically due to lack of blood flow or infection. In coding practice, especially in ICD-10-CM, it is critical to prioritize conditions that pose significant risks to patient health. Gangrene can lead to severe complications, including sepsis, amputation, or even death, making it essential to address this diagnosis as the primary focus in medical records.

Other conditions, while serious, do not carry the same immediate risk of life-threatening consequences that would necessitate them being coded before gangrene. This prioritization reflects the coding guidelines that require coders to capture the most severe or acute conditions impacting the patient's health status first. Proper coding ensures accurate representation of the patient’s clinical picture and impacts treatment decisions and healthcare management.