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Causal relationship with DM

CKindred

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I was at a AAPC chapter meeting and the presenter stated that we are to assume a causal relationship between DM and chronic conditions. I've been trying to verify this since the meeting and can't find it anywhere in the guidelines. Does anyone know where I can find proof of this new guideline if it is indeed a new guideline? My peers agree with me and we're going to code separate if they're not properly linked.
 

thomas7331

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You'll find this in your ICD-10 guidelines in section 1 A, paragraph 14, where is describes the correct interpretation of the word "with" in the index. The presumed relationship is not for all chronic conditions, but just for those in the ICD-10 that are linked with that term. So for any condition listed in the index under DM after the term "with" or "in", you will use the code that shows the relationship unless the provider has documented otherwise:

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 condition 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....
 

CKindred

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I understand that, I mean without the terms linking them. The presenter stated that if we see Type 2 DM and CKD that we are to automatically assume that they are linked like we do with HTN and CKD or CHF.
 

thomas7331

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Yes, I think it's pretty clear in the ICD-10 instructions that if those terms appear in the ICD-10 index or list, that means that the provider does not have to use any terms to link them in the documentation, and that they should be coded as related unless the provider has specifically stated otherwise. So Type 2 DM and CKD is always coded as E11.22, N18.- unless the provider has said that the CKD is not related or not caused by the DM. .
 

mitchellde

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I think you are misunderstanding. The guideline for the word with is not referring to if the provider uses the word with to link them , it means when the word with is used in the index or tabular list in the codes set. Go to diabetes in the index of your codebook, then say type II under the subterm type II you see the word with, any condition indented under the word with is considered automatically linked and does not have to be documented as such by the provider. The guideline even states this.
 
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