ICD 9 Primary Diagnosis Clarification

I'm a new coder for a Hospice organization and there are conflicting views regarding the coding of primary diagnosis codes that are "probable", "suspected", "most likely", etc.

My understanding of the ICD9 guidelines for the outpatient setting to only code certain diagnosis codes. For "uncertain" diagnosis codes, signs and symptoms should be used.

Also in the ICD 9 coding guidelines is Section II - Selection of Principal Diagnosis. My understanding of this section is that is only pertains to the inpatient setting (i.e. short term, acute, long term care, and psychiartic hospitals.

Am I understanding this correctly?

Being a hospice agency, we do have hospice patients that are GIP (general inpatient) at our local hospitals. When I'm selecting "uncertain" diagnosis codes, should I follow the guidelines for the outpatient setting or the inpatient setting.

I'm wondering if I have two sents of ICD-9 coding guidelines that I should be following.

Please help!

ICD 9 Primary Diagnosis Clarification