Wiki Diabetes and CKD

SJeanG

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There was discussion today at work surrounding the relation between diabetes and chronic kidney disease. I know when hypertension and ckd are present, it's to be assumed that the coding should link the two, I12.9 and N18.X, the way I understand the guidelines is that unless the provider relates the two, diabetes in/with ckd, we are not to assume the relation and coding should be E11.9 and N18.X. Can anyone please clarify?

Thanks,
Sherry
 
E11.22 is DM2 "with" CKD


"The subterm “with” in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word “with.” The physician documentation does not need to provide a link between the diagnoses of diabetes and chronic kidney disease to accurately assign code E11.22, Type 2 diabetes mellitus with diabetic chronic kidney disease. This link can be assumed since the chronic kidney disease is listed under the subterm “with.” 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 and due to some other underlying cause besides diabetes. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related. ."


Also:

 
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I agree with Mayzoo,

You can link them, since your index does have "with" under diabetes. Any manifestations you find under diabetes can be linked without provider stating they are related to diabetes.

diabetes
-with
--amyotrophy
--cataract
--foot ulcer
--gangrene
--neuralgia

because of that guideline for "with" you can use the combo code for diabetes as long as the patient has the conditions.

When would you not linked them? Well let me give you an example, i've seen cases where the patient is diagnosed with CKD due to IgA nephropathy and the patient is diabetic. Record specifically indicates that it was due to IgA nephropathy, so at that point i will use the E11.9 as they stated CKD had a specified reason.

Hope it helps!
 
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