Use of the Manual 23
be considered “principal” for an individual hospitalized with both schizophrenia and al-
cohol use disorder, because each condition ma y have contributed equally to the need for
admission and treatment. The principal diagnosis is indicated by listing it first, and the re-
maining disorders are listed in order of focu s of attention and treatment. When the prin-
cipal diagnosis or reason for visit is a ment al disorder due to another medical condition
(e.g., major neurocognitive disorder due to Alzheimer’s disease, psychotic disorder due to
malignant lung neoplasm), ICD coding rules re quire that the etiological medical condition
be listed first. In that case, the principal diagnosis or reason for visit would be the mental
disorder due to the medical condition, the seco nd listed diagnosis. In  most cases, the dis-
order listed as the principal diagnosis or the reason for visit is followed by the qualifying
phrase “(principal diagnosis)” or “(reason for visit).”
Provisional Diagnosis
The specifier “provisional” can be used when there is a strong presumption that the full
criteria will ultimately be met for a disord er but not enough information is available to
make a firm diagnosis. The clinician can indi cate the diagnostic uncertainty by recording
“(provisional)” following the diagnosis. For example, this diagnosis might be used when
an individual who appears to ha ve a major depressive disorder  is unable to give an ade-
quate history, and thus it canno t be established that the full cr iteria are met. Another use of
the term provisional is for those situations in which differential diagnosis depends exclu-
sively on the duration of illness. For example,  a diagnosis of schizophreniform disorder re-
quires a duration of less than 6 months bu t of at least 1 month and can only be given