Wiki Causal Relationship

[LuckyLily]

Hello,

Is there a causal relationship (presumed, no provider linkage needed) between Pathological fracture and neoplastic disease? Neoplastic disease is under the sub-term 'due to'. If I pick a location such as L ankle (initial encounter for fracture), the dx is M84.572A-Pathological fracture "in" neoplastic disease, left ankle, initial encounter for fracture.

Per coding guidelines, Section I.A.15, it states- The word "with" or "in' should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alpha Index or an instructional note in the Tabular List.

What is defined as the code title? Is it the diagnostic statement the provider documents, or is it the code found after looking up the condition under 'due to' in the Alpha Index?

This question has come up, because I always thought that the provider has to link the two terms together if there is a 'due to'.

Thank you for your help.

 

[thomas7331]

Although 'code title' isn't explicitly defined in the guidelines, it's pretty clear that this is used to refer to the code descriptor, i.e. the verbiage associated with a given code in the ICD-10 Tabular List, not the provider's documentation.

So given the ICD-10 guidance you've cited on 'with' and 'in', there would be a presumed relationship between a pathological fracture and neoplastic disease because of the code title in the M84.5- category, even without a provider explicitly documenting it. Keep in mind though that a pathological fracture, by definition, is a fracture that is caused by a disease and not by trauma. If a provider is documenting a pathological fracture, you know already that there must be another disease present that is responsible for the fracture. If the patient has multiple co-morbidities (e.g. a patient who has osteoporosis and cancer) and it is not clear which of these is associated with the fracture, then it may be necessary to query the provider (and they may or may not have the answer). You see a similar situation to this when a patient with both CKD and cancer is diagnosed with anemia since the anemia carries a presumed relationship with both of these.

 

[LuckyLily]

So to make sure I understand,

The provider does not have to link pathological facture 'due to' neoplastic disease in the Alphabetical Index to arrive at the code? I thought that the only time we can assume a relationship is when 'with' or 'in' is listed under the main term or sub-term?

As for what is the code title, thank you for clarifying it is the code descriptor in the ICD-10 Tabular List.

 

[thomas7331]

So to make sure I understand,

The provider does not have to link pathological facture 'due to' neoplastic disease in the Alphabetical Index to arrive at the code? I thought that the only time we can assume a relationship is when 'with' or 'in' is listed under the main term or sub-term?

As for what is the code title, thank you for clarifying it is the code descriptor in the ICD-10 Tabular List.

From the guidelines:

"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."

The relationship is presumed when the word 'in' appears in either of the specified locations - it does not have to appear in the Alphabetic Index if it appears, as in this case, in the code title within the Tabular List.

 

[LuckyLily]

So what happens to the 'due to' when we are finding a code in the Alpha Index. For example, Anemia has 'with', 'due to', and 'in' listed as sub-terms and all of them have different diagnosis listed under them. Doesn't the provider have to associate Anemia with a condition if we are looking under the 'due to'?

 

[thomas7331]

So what happens to the 'due to' when we are finding a code in the Alpha Index. For example, Anemia has 'with', 'due to', and 'in' listed as sub-terms and all of them have different diagnosis listed under them. Doesn't the provider have to associate Anemia with a condition if we are looking under the 'due to'?

Correct, if the entry is listed under 'due to', (e.g. anemia due to blood loss) then the causal relationship must be documented by the provider. Only those conditions listed under the terms 'with' or 'in' (e.g. CKD, ESRD, neoplastic disease under 'anemia' -> 'in') have a presumed relationship unless the provider specifically documents that they are not related.

 

[LuckyLily]

Correct, if the entry is listed under 'due to', (e.g. anemia due to blood loss) then the causal relationship must be documented by the provider. Only those conditions listed under the terms 'with' or 'in' (e.g. CKD, ESRD, neoplastic disease under 'anemia' -> 'in') have a presumed relationship unless the provider specifically documents that they are not related.

So why wouldn't we need to have the provider document the causal relationship between pathological fracture and neoplastic disease in the note? Neoplastic disease is under 'due to'.

Fracture, pathological
>due to
>neoplastic disease NEC
>ankle,carpus,clavicle......
>osteoporosis
>specified disease NEC

 

[thomas7331]

So why wouldn't we need to have the provider document the causal relationship between pathological fracture and neoplastic disease in the note? Neoplastic disease is under 'due to'.

Fracture, pathological
>due to
>neoplastic disease NEC
>ankle,carpus,clavicle......
>osteoporosis
>specified disease NEC

Because the term 'in' appears in the code title in the Tabular List. I don't know why these two would be linked by one term in the Tabular List and a different one in the Alphabetic Index, but guidance states that if 'in' appears in either place, then the causal relationship is presumed. At least that has been my interpretation.

There are cases of contradictory and confusing guidance in ICD-10 and this is one of them. In those situations you sometimes just have to interpret the guidance to the best of your ability and use your judgment. It's the nature of coding that there aren't clear-cut answers for every situation. If it is something you're running into frequently in your practice and you feel it needs to be addressed on a more official level, you may want to consider submitting your question to AHA or Coding Clinic or your specialty's professional society to try to get some official documented guidance on it.

 

[natashalage]

Good topic coders! I am 2 year old coder. I was not clear on 'due to' but I found the extract in Official coding guidance on page V of 2020 book. It says ' The word ' with ' or ' in ' should be interpreted to mean ' associated with' or ' due to'. The classification presumes a causal relationship between the two conditions linked by these terms in the index." You fill find this under bold title ' Index Notations' page v.