Hypertension with DM


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Trying to make sure i understand the guidelines, having trouble how to capture dx.

HTN " with" DM
HTN "associated with" DM

The guidelines in the ICD-10 book on page 19.

15. “With” 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”).

If a provider happens to use the word “with” I can assume and interpret to mean the same as “ associated with “ or “ due to “ based on the code title in the alphabetic index.

Example: HTN with DM

if I go to index under HTN, then looking for “ with “, I don’t see anything for DM/endocrine. BUT per guideline in pg 19, I can go to HTN > due to> endocrine disorder (DM) – I15.2, E11.9 (code underlying condition) because I can interpret “ with “ to mean the same as “due to” , which would be I15.2, E11.59

is this correct?

In the index, I don't see anything for HTN "associated with", just because the word "with" is in there is it to interpret as well as "due to" ?????


Walnut Creek, CA
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I see no-one responded to you yet, so I would like to participate in your dialogue but please don't take my answer as the correct one since I am a new coder. My thoughts are: yes, you can view ' associated with'= 'with'= 'due to'- as the same interpretation. As for HTN with endocrine disorder, I don't think we should interpret it as the HTN with DM. I remember reading an article in AAPC magazine about Diabetes With Ophthalmology complication where you cannot use such complication for something specific that is documented. They stated that MD should connect such condition together in his note. I say if the Index does not have DM under HTN, then we cannot use as linked.


True Blue
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The guidance is that the term 'with' implies that the causal relationship between the two conditions can be assume when the 'with' "appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List." It can NOT be assumed when 'with' is used in provider documentation. In other words, 'with' can be understood to mean 'due to' when found in ICD-10, but 'with' does NOT mean 'due to' in provider documentation.

This is a linkage that is built into ICD-10, so the guidance is instruction on how to code - it is not guidance on how to interpret the provider's words. So if you encounter the term 'with' in ICD-10, the two conditions can be presumed related for coding purposes, whether or not the provider has documented that relationship. But if a provider documents 'with', you would not use that to assume that they are causally related - the provider must state that relationship explicitly.

So you're correct that 'with' does NOT occur in ICD-10 between DM and HTN, so no relationship can be assumed. If the provider has documented "DM with HTN" or "DM associated with HTN", it would be coded with E11.9 and I10.