Coding Clinic Q1 2016 Addresses Diabetic Complications

In the Q1 2016,  AHA Coding Clinic addresses a number of issues--two of which are hot topics for coders in risk adjustment.

Most of the questions we get in the Coding Inbox (coding@scanhealthplan.com) deal with "Diabetes and ______________", and whether or not the ICD-10CM assumes a causal relationship.  Usually, this is because the physician has not made a link in the medical record, and the coder is unsure whether or not they can code the diabetic complication.

In ICD-9, the question also came up a lot--and most often, the answer was NO.

Coding Clinic took this subject on once again, for ICD-10CM..  In Section I. Conventions, general coding guidelines and chapter specific guidelines of the Official Guidelines for Coding and Reporting, the ICD-10 describes how the word "with" is to be interpreted:



15.     “With”

The word “with” should be interpreted to mean “associated with” or “due to”
when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular 
List.

In a code title, the association might look like this:

E11.31  Type 2 diabetes mellitus with unspecified diabetic retinopathy

This tells you that there is an association between the two diseases.
_____________________________________________________________

The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in
alphabetical order.

In part, the Alphabetic Index under "Diabetes" looks like this:

Diabetes, diabetic (mellitus) (sugar) E11.9
- with
- - amyotrophy E11.44,- - arthropathy NEC E11.618
- - autonomic (poly)neuropathy E11.43
- - cataract E11.36
- - Charcot's joints E11.610
- - chronic kidney disease E11.22
- - circulatory complication NEC E11.59
- - complication E11.8
- - - specified NEC E11.69
- - dermatitis E11.620
- - foot ulcer E11.621
- - gangrene E11.52
- - gastroparesis E11.43
- - glomerulonephrosis, intracapillary E11.21
- - glomerulosclerosis, intercapillary E11.21
- - hyperglycemia E11.65
- - hyperosmolarity E11.00
- - - with coma E11.01
- - hypoglycemia E11.649
- - - with coma E11.641
- - kidney complications NEC E11.29
- - Kimmelsteil-Wilson disease E11.21
- - loss of protective sensation (LOPS) —see Diabetes, by type, with neuropathy
- - mononeuropathy E11.41
- - myasthenia E11.44
- - necrobiosis lipoidica E11.620
- - nephropathy E11.21
- - neuralgia E11.42
- - neurologic complication NEC E11.49
- - neuropathic arthropathy E11.610
- - neuropathy E11.40
- - ophthalmic complication NEC E11.39
- - oral complication NEC E11.638
- - periodontal disease E11.630
- - peripheral angiopathy E11.51

With this new Coding Clinic clarification, when the physician documents and another disease, you need to check the Alphabetic Index first, to see if the problem/complication is listed there, and then as always, go to the code itself.  If the condition is qualified by the term diabetes with ____, the you can code the complication.  The doctor does not have to state the complication--it is assumed.   If you don't find that causal relationship is supported, then the two diseases are coded as unrelated.

This clarification should help make coding more accurately reflect what the physician is trying to convey to the coder.  As always, we as coders have to be careful to ensure that we double check the ICD-10CM to be sure we're coding it right.