Wiki Diabetes and has ulcer question

[LuckyLily]

I've come across the Coding Clinic 2017 4Q pg 100-1 that address the NEC conditions listed under the 'with' for Diabetes. It states;
'The "with" guideline does not apply to "not elsewhere classified (NEC)" index entries that cover broad categories of conditions. Specific conditions must be linked by the terms "with," "due to" or "associated with". Coding professionals should not assume a causal relationship when the diabetic complication is "NEC".


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So my question is, a patient has diabetes and a ulcer is documented (not on foot) and MD did not state they are together. These two conditions cannot be linked because in the index, under 'with' the 'skin ulcer' has a NEC. Do you agree they should not be linked or do most people link them?

I've never been instructed about the NEC rule and unfortunately I was under the impression that you could link any ulcer with diabetes.

 

[thomas7331]

I agree with you. The term 'ulcer' by itself (and not qualified as a 'foot ulcer' or a 'diabetic ulcer') is not linked in the ICD-10 to diabetes, so without documentation to support that it is a complication of the diabetes, we would not presume the causality and would code them separately.

 

[bberube10]

These are assumed conditions unless the documentation specifically states that it is not Diabetic. The word “with” 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.

From the Coding Clinic

"As many of you have probably heard, Section A.15 of the new Guidelines states that any time the word “with” appears, either in the Alphabetic Index or in an instructional note not in the Tabular List, the classification presumes a causal relationship and the conditions will be linked even in the absence of provider documentation. Coding Clinic reiterates this fact. For CDI specialists, this may seem like a good thing, but it also means we need to do our homework and make sure all these assumed relationships are truly related. We may find we need more queries to verify these cases with the providers. So be careful and go over each case to make sure it is an accurate representation of what is going on with your patients."