Wiki Coding DM type 2 with Hypertension and Hyperlipidemia

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angelalhale

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I am struggling with using E11.59 and E11.69. The provider has documented the patient has Diabetes type 2 and hypertension and hyperlidemia. Would it be appropriate to code either E11.59 or E11.69 for either of these diagnosis? I keep getting conflicting advice from others and still feel very confused as to what is correct.
 
angelalhale said:
I am struggling with using E11.59 and E11.69. The provider has documented the patient has Diabetes type 2 and hypertension and hyperlidemia. Would it be appropriate to code either E11.59 or E11.69 for either of these diagnosis? I keep getting conflicting advice from others and still feel very confused as to what is correct.
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I was trying to find a way to share a Humana handout I had from attending a webinar on coding DM but came across this which matches what the handout said. This is a reply from someone else's question regarding the same thing. Hope this helps.

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:

https://journal.ahima.org/2016/05/11/coding-diabetes-mellitus-with-associated-conditions/

Coding Tip: Coding Diabetes Mellitus with Assumed Conditions

Diabetes and hypertension are not presumed to be related unless the provider specifically documents that it is.
 
I agree, you would not use a complication of diabetes code for either hypertension or hyperlipidemia unless the provider specifically states that the diabetes caused them. I think it would be very rare to see that - the conditions commonly occur together but in many years of coding I've never encountered a provider who documented that one of these was caused by the diabetes.
 
Per coding guidelines, unless the provider specifically states that there is a link between the two diagnosis, you would not 'assume' the link between the two. I understand you're thinking behind it and trying to code to the highest level.
 
angelalhale said:
I am struggling with using E11.59 and E11.69. The provider has documented the patient has Diabetes type 2 and hypertension and hyperlidemia. Would it be appropriate to code either E11.59 or E11.69 for either of these diagnosis? I keep getting conflicting advice from others and still feel very confused as to what is correct.
Click to expand...
I have the rare scenario where the provider links both HTN and DM and HLD and DM and I used E1169. My auditor says DM w/ HTN is E1159 but isn't HLD also a circulatory condition? I will state again for clarity. The provider HAS linked the DM to both HTN and DM...what should I code? Her rational is HTN is classified into ch. 9 Diseases of the circulatory system....HLD is ch. 4 Endocrine, Nutritional and Metabolic Diseases Therefore Ell59 for DM linked to HTN and E1169 for DM linked to HLD. Hope this helps those wondering why like me. ;)
 
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Hi , I am not an expert but this topic was discussed this year in the forum.Try to use the Search field and find that dialogue. I remember that DM and i10 are not linked by Index But if your MD linked them in the documentation, then yes, DM with circulatory system code (for i10). I guess similar rule will apply to HLD but I don't know what system HLD belongs to...-Other?
 
In the ICD-10 index, the listed complications below Diabetes are the only ones we may presume a connection per my auditor. All others will need to be documented as being related.
 
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