Wiki Coding Diabetes with Circulatory Complications

nesha2566

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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.
 
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.
 
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!!:)
 
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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