Wiki HTN associated with DM or visa versa

KoBee

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Need assistance,
There is some discussion in trying to find correct HCC diagnosis for the following:

whether a provider documents, HTN associated with DM or visa versa, would correct DX be E11.59 and I15.2? HELP!
 
As a coder if documentation states hypertension due to dm I would code the E08.59 and I10 must be primary as the E08.59 is a manifestation code.
Remember that due to also means "with or in".
Below is an HCC snip-it from 3m:
HCC Opportunity

Patients with diabetes may develop conditions which affect other body systems. These conditions are referred to as manifestations. Look for common manifestations such as renal and neurological manifestations and hypoglycemia in diabetes.

Disease Interactions for Community-based or Institutional-based Beneficiaries

In the CMS-HCC model specific condition pairings are considered disease interactions and indicate that the presence of both conditions predicts a higher spending than the sum of the individual increments.

Diabetes and Congestive Heart Failure
Review for documentation of heart failure, pulmonary embolism, pulmonary hypertension, and cardiomyopathy to ensure accurate reporting of HCC Disease Interactions.

This condition has been identified as part of a Hierarchical Condition Category (HCC). HCCs were developed by CMS to adjust Medicare capitation payments to private health care plans based on the health expenditure risk of their enrollees. The most severe manifestation of a disease within each category should indicate predictive cost of care.

HCC 19 - Diabetes without Complications
© 2022, 3M. All rights reserved. Use is governed by the terms of a license agreement. Disclosure to third parties is prohibited without 3M's written consent. 3M makes no claim to third party or government works.

If DM due to hypertension codes would be I15.2 and E11.9 sequence would be based on circumstance of encounter.
In both cases the HCC would be 19. Happy coding!
 
Last edited:
Need assistance,
There is some discussion in trying to find correct HCC diagnosis for the following:

whether a provider documents, HTN associated with DM or visa versa, would correct DX be E11.59 and I15.2? HELP!
Per the ICD-10 guidelines, there is no presumed causal relationship between diabetes and hypertension, so these should be coded as E11.9 and I10 unless the provider documents that one is caused by the other. The presence of the term 'with', when it appears in ICD-10, requires the coder to presume a relationship (unless documented otherwise) but not when this term appears in the medical record. I do not interpret 'associated with' to mean 'caused by' or 'due to', although different organizations may have their own internal guidance to this effect.
 
Per the ICD-10 guidelines, there is no presumed causal relationship between diabetes and hypertension, so these should be coded as E11.9 and I10 unless the provider documents that one is caused by the other. The presence of the term 'with', when it appears in ICD-10, requires the coder to presume a relationship (unless documented otherwise) but not when this term appears in the medical record. I do not interpret 'associated with' to mean 'caused by' or 'due to', although different organizations may have their own internal guidance to this effect.
This is one of biggest debates on how they interpret " associated with ". Because the coding will be different. I see many HCC coders do interpret as meaning " caused by" or " due to ". I would like to say I do no interpret the same. Associated and due to are two different meanings, right!?

Appreciate your feedback. Thank you so much. I'm so glad we have these forums.
 
This is one of biggest debates on how they interpret " associated with ". Because the coding will be different. I see many HCC coders do interpret as meaning " caused by" or " due to ". I would like to say I do no interpret the same. Associated and due to are two different meanings, right!?

Appreciate your feedback. Thank you so much. I'm so glad we have these forums.
Yes, I agree with you, 'associated' means 'related to', but not necessarily 'caused by', and I think it's a somewhat ambiguous term. But the only way to know for sure what is intended by this wording would be to ask the providers since they're the ones writing it, and different providers may been using these terms in slightly different ways. So I think this is an example of an instance where it's important for an organization to have some kind of a policy as to how this is going to be interpreted, and the providers would need to be involved in developing that policy so they can give their input on what exactly they mean in the documentation and also have an understanding of how their coders are interpreting their words.
 
HTN associated with DM
I understand that in the alpha index the with guideline can't be presumed; however, if the quote above is documented by the physician then wouldn't that be the linkage verbiage?

“With”
The word “with” or “in” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).
For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related.

Code title for I15.2 Hypertension secondary to endocrine disorder
Under alpha index hypertension, due to, endocrine disorder I15.2

associate to join or connect together
 
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