Coding Diabetes with Hypertension

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Looking for opinions on coding Diabetes with Hypertension.

When coding in book, hypertension is not listed as a specified complication. Since hypertension is considered a circulatory complication I feel the correct code is E1159 rather than the more unspecified code of E1169 (other specified complication).

How do you code this? Do you know of any Coding Clinics regarding this?

Thank you!
 
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Thanks for that answer but this example is specifically for when:

Diabetes is documented and supported with a complication of Hypertension.
 

thomas7331

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As I understand the guidelines, if the provider has only documented "diabetes with hypertension", then you would not presume a causal relationship between the two because the two terms "diabetes" and "hypertension" are not linked in ICD-10 by the term "with". If the provider has specifically documented that the hypertension was caused by the diabetes, then you would code the hypertension as a circulatory complication. Only the terms listed in the index under "diabetes with" should be coded as a complication with specific documentation linking them. See the instructional note in Section I, part A - Conventions for the ICD-10-CM:

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, 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....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.
 

LakeshD

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we should code diabetes-E11.9 and hypertension-I10 separately. Diabetes is not always associated with hypertension, We should read provider documentation clearly and code it accordingly.
 

kreuder

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Per our recent Humana audit, it was indicated that diabetes and hypertension have an assumed relationship and it should be coded as E11.59 (for type 2 diabetic.) We did not code them this way and got dinged every visit they audited for us coding I10 and E11.9. I disagreed with the lady, but they are then ones doing the auditing....
 

michellepilcher

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I found this reference at AHIMA:

Regarding the assumption of the connection between DM and HTN, please see Coding Clinic 4th QTR 2017 and 2nd 2018. In order to assume a "with" connection the specific condition must be listed in the Alphabetic Index or Tabular List. "NEC conditions" are not assumed to be related. In your example, HTN is not specifically listed as an assumed diabetic complication so the code for Diabetes with other circulatory condition should not be assigned. The exception to this would be if the documentation specifically makes the connection, "HTN due to DM". This would be very rare to come across.

An example of assuming the connection would be if the patient is diagnosed with both Diabetes and Retinopathy. In that case the connection is assumed and the appropriate combination code would be assigned.

Also these articles:



Diabetes and hypertension are not presumed to be related unless the provider specifically documents that it is.
 
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