Wiki Coding Diabetes Code E11.69

[ossierand]

Hello
I am hoping that someone can shed the light for me on this dx. I am working with providers and coders, I just started working there, and apparently they are under the impression that E11.69 which is other complications
can be used with Hyperlipidemia and Hypertension? now I always thought that we cannot use this specific linkage. AM I wrong to assume this?? I mean l suggested for them to look at the guidelines and the index under
the word "with" and those two are not found there. Now in order for me to convince them I need a reputable source that I can use. I used to have access for optum's AHA however now I don't does anyone have any suggestions?
or a another opinion on this subject??

 

[thomas7331]

The guidance on the 'with' and 'in' can be found in the ICD-10 Official Guidelines, Section 1.A.15, which are located at the front of your ICD-10 book, or if you don't have a book, you can also download the guidelines on the CDC web site. Here is the relevant part of the text of that section:

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.

That said, if the provider does document that either of these conditions is a complication of or is caused by the diabetes, then you would use the diabetes complication codes, such as E11.69 in the case of hypertension.