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Icd-10 coding guideline

  1. Default Icd-10 coding guideline
    Medical Coding Books
    Shall we bill E11.40(Combination code)for DM and CKD documented with out linakge

    In the below link from AHIMA stated we can bill E11.40 combination code since the physician documentation does not need to provide a link between the diagnoses of diabetes and CKD

    NOTE-The above mentioned guideline not available in ICD-10-CM Official Guidelines

    LINK-http://journal.ahima.org/2016/05/11/coding-diabetes-mellitus-with-associated-conditions/

  2. #2
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    Code E11.40 would be used to report Type 2 diabetes mellitus with diabetic neuropathy. Please look at E11.22 and see instructional note to use additional coding for the CKD being reported N18.1-N18.6
    2017 ICD-10 guidelines Chapter 14 a.3 states the following....

    "3) Chronic kidney disease with other conditions
    Patients with CKD may also suffer from other serious
    conditions, most commonly diabetes mellitus and hypertension.
    The sequencing of the CKD code in relationship to codes for
    other contributing conditions is based on the conventions in the
    Tabular List"

    Hope this was helpful.
    Last edited by Lynda Wetter; 06-27-2017 at 07:59 AM.
    Thank you,
    Lynda Wetter CPC, CPMA, CEMC, CGSC
    AAPC-Chapter Association Board of Directors 2017-2020
    Region 3, Virginia, West Virginia, North Carolina, South Carolina, Kentucky
    Vice President Richmond Virginia Chapter 2017
    Lynda.Wetter@AAPCCA.org

  3. #3
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    Quote Originally Posted by sarul.sekar1@gmail.com View Post
    Shall we bill E11.40(Combination code)for DM and CKD documented with out linakge

    In the below link from AHIMA stated we can bill E11.40 combination code since the physician documentation does not need to provide a link between the diagnoses of diabetes and CKD

    NOTE-The above mentioned guideline not available in ICD-10-CM Official Guidelines

    LINK-http://journal.ahima.org/2016/05/11/coding-diabetes-mellitus-with-associated-conditions/
    The guideline is in the official guidelines... Look for the instructions for the word "with". The look in your codebook in the alpha section under the keyword diabetes. since chronic kidney disease is listed under the word "with" then it is an automatic relationship with the diabetes and coded as E11.22, E10.22, E09.22, or E08.22) and does not need to be documented in the chart note as causal.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
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    Correct, to confirm Diabetes with CKD is reported with E11.22 not the E11.40 you first mentioned. You will also need to assign the code for the stage of the CKD.
    The quoted statement I made previously is found in the 2017 guidelines. You should also be looking at a current year 2017 ICD10 code book which will show E11.40 as "Diabetes with diabetic neuropathy"
    I do urge that when referencing guidelines to assist you, that you use the 2017 guidelines for up to date reference.

    https://www.cdc.gov/nchs/data/icd/10...2017_final.pdf
    Last edited by Lynda Wetter; 06-27-2017 at 07:58 AM.
    Thank you,
    Lynda Wetter CPC, CPMA, CEMC, CGSC
    AAPC-Chapter Association Board of Directors 2017-2020
    Region 3, Virginia, West Virginia, North Carolina, South Carolina, Kentucky
    Vice President Richmond Virginia Chapter 2017
    Lynda.Wetter@AAPCCA.org

  5. #5
    Post "With" vs "And"
    Quote Originally Posted by sarul.sekar1@gmail.com View Post
    Shall we bill E11.40(Combination code)for DM and CKD documented with out linakge

    In the below link from AHIMA stated we can bill E11.40 combination code since the physician documentation does not need to provide a link between the diagnoses of diabetes and CKD

    NOTE-The above mentioned guideline not available in ICD-10-CM Official Guidelines

    LINK-http://journal.ahima.org/2016/05/11/coding-diabetes-mellitus-with-associated-conditions/
    The answer to your question is NO. You cannot report combo code for DM AND CKD (E11.22+N18.x) if the Provider didn't document the linkage, as per ICD-10 guidelines and your AHIMA article listed. The word "with" is an acceptable linkage, the word "AND" is not, as stated in page ix of Overview of ICD-10-CM Official Conventions. Your code selection if both conditions are reported without linkage should be: E11.9 and N18.x.
    Last edited by eortega; 06-30-2017 at 09:51 AM.

  6. #6
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    Please read your guidelines carefully. Look in the general guidelines for the instructions for the word with.
    15. “With”
    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.
    You see it is not when the provider states with, it is when the alpha section uses the word with under the main term. It clearly states the provider does not need to document the relationship. So it is an automatic causal condition if listed under the word with.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Arrow Presumed causal relationship for HTN + CKD only
    Quote Originally Posted by mitchellde View Post
    Please read your guidelines carefully. Look in the general guidelines for the instructions for the word with.
    15. “With”
    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.
    You see it is not when the provider states with, it is when the alpha section uses the word with under the main term. It clearly states the provider does not need to document the relationship. So it is an automatic causal condition if listed under the word with.
    Hi Debra,

    Could you please provide the page number of the 2017 ICD-10 guidelines for your statement above specifically related to DM complications? I only found causal relationship presumed for Hypertension and CKD: "The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term “with” in the Alphabetic Index. 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." Reference: Page 604, 2017 ICD-10 book.

    In the original poster's question: Shall we bill E11.40(Combination code)for DM and CKD documented with out linakge? neither the Physician documents relationship nor the word "with" is used.

    Page ix of 2017 ICD-10 Overview of ICD-10-CM Official Conventions states:
    And
    When the term “and” is used in a narrative statement or code title it may be interpreted as “and/or.”
    With
    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.

  8. #8
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    Quote Originally Posted by eortega View Post
    Hi Debra,

    Could you please provide the page number of the 2017 ICD-10 guidelines for your statement above specifically related to DM complications? I only found causal relationship presumed for Hypertension and CKD: "The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term “with” in the Alphabetic Index. 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." Reference: Page 604, 2017 ICD-10 book.

    In the original poster's question: Shall we bill E11.40(Combination code)for DM and CKD documented with out linakge? neither the Physician documents relationship nor the word "with" is used.

    Page ix of 2017 ICD-10 Overview of ICD-10-CM Official Conventions states:
    And
    When the term “and” is used in a narrative statement or code title it may be interpreted as “and/or.”
    With
    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 guideline pasted in my response is from the 2017 guidelines number 15 in the section for general guidelines. It is exactly from where you posted your quote, you just did not post the entire guideline. The very next sentence and on is exactly as I pasted in my response.
    In addition, coding clinics issued a coding clinic regarding specifically CKD and diabetes. In this issue they also referenced this guideline.
    If you notice the guideline does not state that the provider needs to document the word with, it states when it appears in a code title, alpha listing, or code instruction. Look at the alpha listing for diabetes, you will notice that immediately, under the main term diabetes there is the term "with" and then indented under the term with, is all of the diabetic complications. This guideline means that when the alpha listing is like this all the terms indented under the word "with" are automatic causal relationships back to the main term. The guideline then further indicates it does not need to be a documented relationship by the provider.
    This same thing is true for hypertension. If you look at the main term hypertension, you see the term with, any condition listed under the term "with" is an automatic causal relationship, this now includes hear failure as well as CKD.
    The new guideline for hypertension was specifically included due to the confusion. However you will notice that in the hypertension guideline they state "as the two conditions are linked by the term "with" in the alphabetic index.
    You must always look in the alpha section and then the tabular as some instructions are subtle.
    Last edited by mitchellde; 07-01-2017 at 06:10 AM.

    Debra A. Mitchell, MSPH, CPC-H

  9. Default
    Thanks for your response..

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