? DM2 with Erectile Dysfunction


True Blue
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ED is not linked to DM2 by 'with' in the index, so you would use E11.9 unless the documentation specifically says that the ED is a complication due to the diabetes. If the provider has stated that this is a complication of the DM2, then I would use E11.69. ED is not classified as a disease of the circulatory system, so I don't believe that E11.59 would be correct.


True Blue
Beaverton OR
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Agreed, the provider has to make the link for us, if the manifestation is not explicitly listed in the Index.

Per OPTUM 360 ICD-10 CM Expert book, page 4:


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 (either under a main term or subterm), 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 or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”). ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 Page 13 of 120 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. The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.

Can also be found online:



True Blue
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All of the descriptions with [NEC] in the index under With require a statement linking