Answer ICD-10

bharathiT

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The documentation states that Hypertension (I10) & DM (E11.9).
In this case , want to code I15.2 (Hypertension secondary to endocrine disorders) AND E11.9(Type 2 diabetes mellitus) or either one combo?

Kindly clarify on this
 

thomas7331

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As per ICD -10 Guidelines, the term With ,or due to ,associated with are interpreted to mean same. index book sates hypertension due to endocrine disorders (I15.2).

Kindly clarify this, have lot of confusiono_O
Yes, you're correct, the terms means the same thing, but they are not interchangeable. In this case the doctor did not document 'due to'.

The ICD-10 guidelines only for a coder to presume the causal relationship (in other words, assume 'due to') when the term 'with' or 'in' appears in a code title, the Alphabetic Index...or an instructional note in the Tabular List. So if you are looking up 'hypertension' in the alphabetic index, the only conditions listed under 'with' are 'heart failure', 'heart involvement' and 'kidney involvement'. So these three are the only conditions which you can conclude are caused by the hypertension in the absence of physician documentation of the causation - if the two conditions both exist at the encounter, you code the entry under 'with' even if there is no relationship documented. However, to code the conditions listed under 'due to', the documentation must support that this condition caused the hypertension.

Another way to look at it is that 'with' and 'in', in ICD-10, mean simple that the two conditions both are present in the documentation. 'Due to' does not allow this - this term must be documented.
 
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thomas7331

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There is no presumed causality between hypertension and DM. If the provider has not documented that this is secondary hypertension, then this should be coded as I10, E11.9.
 

bharathiT

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Please explain the ICD -10 Guideline?


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. 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. 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.
 

michellepilcher

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Please explain the ICD -10 Guideline?


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. 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. 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.

It means just that. If a patient has chronic kidney disease and hypertension, it is presumed they are related and they are linked. If the patient has cardiovascular disease and hypertension it is presumed they are linked. In those cases there is a code that links them rather than using two separate codes. There is no code that links diabetes and hypertension. I15.2 is secondary hypertension. Those types of illnesses are aldosteronism, pheochromocytoma, Cushing's syndrome, hyperparathyroidism and hypo- and hyperthyroidism.
 

bharathiT

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As per ICD -10 Guidelines, the term With ,or due to ,associated with are interpreted to mean same. index book sates hypertension due to endocrine disorders (I15.2).

Kindly clarify this, have lot of confusiono_O
 

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Munzueta

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Hello,

completely agree with above.

So if I may add, in other words, if you want to use I15.2, your index will have to show something like this.

Hypertension
with
diabetes mellitus

that will be the only way you could code it as such, but well the book doesn't have it, just be careful with the "with" and "in"

you will not be linking every single condition with diabetes, only the ones listed on the alphabetic index for example,

Diabetes
with
amyotrophy
arthropathy
chronic kidney disease

so if a patient has a diagnosis of Chronic kidney disease and diabetes, and there is no linkage of both conditions, in this case you would be able to code with the E11.22 combining CKD and diabetes and then also adding the N18.9. We are doing this because your index provides a specific "with" entry for chronic kidney disease under diabetes melliltus.

Hope this paints a better picture!
Marco
 
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