Major Depression vs Poisoning

What are thoughts about the proper PDx when a patient is admitted with an intentional suicide attempt by overdose, resulting secondary to a newly diagnosed severe major depressive episode?  The overdose was with Norco and Tylenol which resolved quickly.  The patient will be transferred to an inpatient psychiatric hospital for further treatment of depression. 


  • As the patient was admitted to an acute care hospital, the principal diagnosis would be on the intentional overdose and the focus would be on treating any signs or symptoms that developed as a result from the overdose.  The newly diagnosed depression, would be a secondary diagnosis.  My thinking is that the transfer to an inpatient psychiatric hospital would be for the treatment of the depression, which would be the principal diagnosis at the inpatient psychiatric hospital.  Depression as a principal diagnosis will map out to a mental health DRG grouping, which would be appropriate for the inpatient psychiatric hospitalization. 

    Hope this helps.

    Karen Bridgeman

    Medical University of South Carolina

  • From the scenario provided, the patient was medically stabilized and/or observed and transferred. If this is the case, the PDX is the poisoning. T40.2x2A for hydrocodone, intentional, initial encounter and T39.1x2A for the acetaminophen, intentional, initial encounter. The psychiatric dx is a secondary dx. 
  • Thanks, that makes sense and I am sure that is correct.  I always stumble on these and probably think too hard about it, as I think about the depression as what is cause of the suicide attempt in the first place and the bigger problem. 
    Thanks Michelle and Karen for your quick responses.
  • Agree with Michelle & Karen above: Pdx= overdose, 2nd dx= depression.
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