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Confusing Guidance on Reporting Glaucoma Coincident with Diabetes


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In the March, 2019 "Healthcare Business Monthly," there is an article titled, "Make the Connection 'With' Causal Relationships," by Jodi Lawrence. It contains the following:
... (3rd bullet of list of scenarios that are exceptions to the "with" convention:}
"If a term (condition) is not listed under the Alphabetic Index or Tabular List, it’s not appropriate to code the conditions as related unless the clinician’s documentation clearly indicates the two are related. This may come into play when reporting “not elsewhere classifiable” (NEC) diagnoses (e.g., kidney complication NEC or ophthalmic complication NEC, as shown in Figure 2). Unless documentation states an NEC condition is related, you may not report an NEC diagnosis “with” another diagnosis."

(next paragraph of article)
"For example, when reporting diabetes, a variety of conditions are subject to the “with” convention, including cataract, chronic kidney disease, foot ulcer, and others. But if documentation indicates the patient is diabetic and has glaucoma, the correct coding is E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication and H40.9 Unspecified glaucoma. Even though there is a “code additional” note stating, “Use additional code to identify manifestation, such as diabetic glaucoma (H40-H42),” it is inappropriate to use the NEC diagnosis code E11.39 because glaucoma is not a term found in this list, and documentation does not link the two together." ... [Emphasis mine]

I'm having trouble interpreting this guidance, because the first bolded sentence seems to tell me to report E11.39 and H40.9 when a patient has type 2 diabetes coincident with glaucoma, yet the second bolded sentence (as well as the gist of the bulleted item I've included above) seems to say NOT to report E11.39 in this instance. What gives? Did the author mean to tell me to report E11.9 rather than E11.39, along with H40.9?


Jim Shaw
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