# Guideline Hypertension, CKD, CHF and Diabetes Mellitus



## wkc12981

Have a question for the guidelines experts!!

Discussion

Assessment plan:
Diabetes with CKD-3
Hypertension

Code: 
E11.22
N18.3
I10

Rationale/opion given is that the physician has linked the DM and CKD utilizing the word "with" and coding guideline for "with" should be interpreted as "associated or due to"

Similar question

Diagnosis
Diabetes with CKD-3
Hypertension
Chronic diastolic CHF

Code: 
E11.22
N18.3
I11.0
I50.32

So is this the correct interpreration of the guidelines as opposed to coding?
I12.9 on the first one.
I13.0 on the second one

Thanks for the help


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## mitchellde

read the guideline carefully.. it does not state when the word "with" is documented byt the provider, it states when the terms are linked by the word "with in the alpha or tabular listing in the code set.  If you turn to the alpha index in the codebook you will look for diabetes, under the word diabetes is the word "with"  any term indented under the word with is considered to be auto linked with the maid term.  the same is true to hypertension.  So look to the alpha section of the codebook and look under diabetes and then look under hypertension.  In addition the guideline goes on to state the provider does not need to document this relationship when the code set indicates the linkage is automation.


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## wkc12981

mitchellde said:


> read the guideline carefully.. it does not state when the word "with" is documented byt the provider, it states when the terms are linked by the word "with in the alpha or tabular listing in the code set.  If you turn to the alpha index in the codebook you will look for diabetes, under the word diabetes is the word "with"  any term indented under the word with is considered to be auto linked with the maid term.  the same is true to hypertension.  So look to the alpha section of the codebook and look under diabetes and then look under hypertension.  In addition the guideline goes on to state the provider does not need to document this relationship when the code set indicates the linkage is automation.



Hi Thanks for you reply. 

The arugment coming from the auditors is that the the provider used the word "with"  and is linking the CKD to the diabetes and meets the criteria of "coded separately if the provider has specifically documenteda different cause"

The same information was provided that you gave.  Any guidance?

Thanks,


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## Munzueta

Hello,

So you actually have 2 guidelines, the one under Section I for conventions, instruction 15 for "with" and you also have a chapter specific guideline on Chapter 9 for your circulatory condition. The guideline "with" which again is also stated at the begining of Chapter 9 states that as long as your Index or Description of the code in the tabular list, any of them 2, have the word "with" you can assume the relationship even when the provider doesnt stated.

For example, for the cases you will provided this is how it should be coded.

*Discussion

Assessment plan:
Diabetes with CKD-3
Hypertension*

Code: 
E11.22
I12.9
N18.3


*Diagnosis 
Diabetes with CKD-3
Hypertension
Chronic diastolic CHF
*
Code: 
E11.22
I13.0
N18.6
I50.32

this is the guideline from Chapter 9 that should be used to reference the case to tell your auditors.
_
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. _

hope this clarifies your concern


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## rhondatalley

*HTN, CKD, CHF and DM*

In the ICD-10-CM® Official Guidelines Section I.A.15, the "with" convention states that conditions that follow "with" after the main term in the index and/or have "with" in the code title are assumed to be linked unless the provider indicates that they are unrelated.  There is also Coding Clinic® guidance that further clarifies this guideline and indicates that there is an assumed link unless the provider says unrelated or states a different cause.

Therefore, since the provider has linked the DM and the CKD in the first example, E11.22 is appropriate.  The hypertension code would be I10.

In the second example, the provider links the DM to the CKD, same as in the first example, so E11.22 and the code for the CKD.  Also, there is an assumed link between the hypertension and the CHF - I11.0 and I50.32



wkc12981 said:


> Have a question for the guidelines experts!!
> 
> Discussion
> 
> Assessment plan:
> Diabetes with CKD-3
> Hypertension
> 
> Code:
> E11.22
> N18.3
> I10
> 
> Rationale/opion given is that the physician has linked the DM and CKD utilizing the word "with" and coding guideline for "with" should be interpreted as "associated or due to"
> 
> Similar question
> 
> Diagnosis
> Diabetes with CKD-3
> Hypertension
> Chronic diastolic CHF
> 
> Code:
> E11.22
> N18.3
> I11.0
> I50.32
> 
> So is this the correct interpreration of the guidelines as opposed to coding?
> I12.9 on the first one.
> I13.0 on the second one
> 
> Thanks for the help


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## wkc12981

Please see the guideline in Chapter 9.  a.Hypertension
The classification presumes a causal relationship between hypertension andheart 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.  

So the "with" in the diabetes diagnosis does not negate the hypertension guideline.  Both diabetes and Hypertension are linked by "with" in the alphabetic index.  Furthermore the provider must indicate that that they are unrelated.  By stating with in the daignosis of the Diabetes CKD, it does not mean he is linking them and not the hypertension as the guideline states we do not have to link the hypertension and heart involvement.  He must specifically state as not due to hypertension.





rhondatalley said:


> In the ICD-10-CM® Official Guidelines Section I.A.15, the "with" convention states that conditions that follow "with" after the main term in the index and/or have "with" in the code title are assumed to be linked unless the provider indicates that they are unrelated.  There is also Coding Clinic® guidance that further clarifies this guideline and indicates that there is an assumed link unless the provider says unrelated or states a different cause.
> 
> Therefore, since the provider has linked the DM and the CKD in the first example, E11.22 is appropriate.  The hypertension code would be I10.
> 
> In the second example, the provider links the DM to the CKD, same as in the first example, so E11.22 and the code for the CKD.  Also, there is an assumed link between the hypertension and the CHF - I11.0 and I50.32


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## ParanthamanK

Hi

Diagnosis:

DM with CKD

PMH:
CKD 


For this scenario , unspecified CKD code N18.9 under mention Code first E11.22 condition. In the code E11.22 only mention N18.1- N18.6. For this scenario  Can I Code CKD unspecified ???


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## YashwanthGowda

ParanthamanK said:


> Hi
> 
> Diagnosis:
> 
> DM with CKD
> 
> PMH:
> CKD
> 
> 
> For this scenario , unspecified CKD code N18.9 under mention Code first E11.22 condition. In the code E11.22 only mention N18.1- N18.6. For this scenario  Can I Code CKD unspecified ???


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