Coding Diabetes with Circulatory Complications

nesha2566

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PLEASE CHIME IN!!

This a general question. In a case were the Dr. documents "Diabetes Type 2 with other circulatory complications" and the patient actively has CAD (which is a circulatory system issue) as well, but the Dr. does not specifically say that the CAD is the diabetic complication. Is it ok to accept the code of "Diabetes Type 2 with other circulatory complications" or should it be down coded to just "Diabetes Type 2" since the Dr. didn't specifically state that the CAD was the complication?

A co-worker and I going over this issue. I stated that I would code it as "Diabetes Type 2 with other circulatory complications". He stated that he would down code it to "Diabetes Type 2" since the Dr. didn't specifically note that the CAD was the circulatory complication.
 
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Using the term "with" indicates a coexisting, not causal, relationship between two conditions, and therefore you'd need to code those two separate conditions (versus "due to" or "caused by"). If the patient already carries a DX of CAD, it would only make sense to attribute the "circulatory complications" with the CAD, not the DM. I would code for the DM and the CAD.
 

nesha2566

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According to the AHA Coding Clinic, First Quarter 2016, pages 11-13, ruled that we CAN assume a "cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves, and circulatory system."

This was my reason for saying that I would go ahead and pick it up as diabetes with circulatory complications. I think this change has caused a lot of coders confusion, which is why I posted to the forum. It just goes to show how some coders interpret things differently, thank you so much for your response!!:)
 

cpc4lib

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With as Cause-And-Effect

According to the AHA Coding Clinic, First Quarter 2016, pages 11-13, ruled that we CAN assume a "cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves, and circulatory system."

This was my reason for saying that I would go ahead and pick it up as diabetes with circulatory complications. I think this change has caused a lot of coders confusion, which is why I posted to the forum. It just goes to show how some coders interpret things differently, thank you so much for your response!!:)

I agree with you. This decision was made as of 2016 per AHA and Coding Clinic.
 
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