# Coding Diabetes with Hypertension



## lel2436@yahoo.com (Aug 10, 2018)

Looking for opinions on coding Diabetes with Hypertension.

When coding in book, hypertension is not listed as a specified complication.  Since hypertension is considered a circulatory complication I feel the correct code is E1159 rather than the more unspecified code of E1169 (other specified complication).

How do you code this? Do you know of any Coding Clinics regarding this?

Thank you!


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## devinmajor14 (Aug 10, 2018)

I would code it as I10 for hypertension and E11.9 for diabetes.


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## lel2436@yahoo.com (Aug 10, 2018)

Thanks for that answer but this example is specifically for when:

Diabetes is documented and supported with a complication of Hypertension.


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## thomas7331 (Aug 10, 2018)

As I understand the guidelines, if the provider has only documented "diabetes with hypertension", then you would *not* presume a causal relationship between the two because the two terms "diabetes" and "hypertension" are not linked in ICD-10 by the term "with".  If the provider has specifically documented that the hypertension was caused by the diabetes, then you would code the hypertension as a circulatory complication.  Only the terms listed in the index under "diabetes with" should be coded as a complication with specific documentation linking them.  See the instructional note in Section I, part A - Conventions for the ICD-10-CM:

_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, 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 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.* _


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## ankenycb@yahoo.com (Jun 14, 2019)

devinmajor14 said:


> I would code it as I10 for hypertension and E11.9 for diabetes.


How about the code of I15.2: Hypertension secondary to endocrine disorders? Would this not be descriptive of the Pt's issues?


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## heartyoga (Jun 14, 2019)

I agree with thomas7331. 
Diabetes does not cause hypertension nor vice versa.


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## LakeshD (Jun 23, 2019)

we should code diabetes-E11.9 and hypertension-I10 separately. Diabetes is not always associated with hypertension, We should read provider documentation clearly and code it accordingly.


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## kreuder (Jul 17, 2019)

Per our recent Humana audit, it was indicated that diabetes and hypertension have an assumed relationship and it should be coded as E11.59 (for type 2 diabetic.)  We did not code them this way and got dinged every visit they audited for us coding I10 and E11.9.  I disagreed with the lady, but they are then ones doing the auditing....


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## michellepilcher (Jul 17, 2019)

I found this reference at AHIMA:

Regarding the assumption of the connection between DM and HTN, please see _Coding Clinic_ 4th QTR 2017 and 2nd 2018.  In order to assume a "with" connection the specific condition must be listed in the Alphabetic Index or Tabular List.  "NEC conditions" are not assumed to be related.  In your example, HTN is not specifically listed as an assumed diabetic complication so the code for Diabetes with other circulatory condition should not be assigned.  The exception to this would be if the documentation specifically makes the connection, "HTN due to DM".  This would be very rare to come across.

An example of assuming the connection would be if the patient is diagnosed with both Diabetes and Retinopathy.  In that case the connection is assumed and the appropriate combination code would be assigned. 

Also these articles:



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




			https://www.hiacode.com/education/icd-10-tip-dm-with-assumed-conditions/
		


Diabetes and hypertension are not presumed to be related unless the provider specifically documents that it is.


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## baroquecoder (Dec 16, 2020)

thomas7331 said:


> As I understand the guidelines, if the provider has only documented "diabetes with hypertension", then you would *not* presume a causal relationship between the two because the two terms "diabetes" and "hypertension" are not linked in ICD-10 by the term "with".  If the provider has specifically documented that the hypertension was caused by the diabetes, then you would code the hypertension as a circulatory complication.  Only the terms listed in the index under "diabetes with" should be coded as a complication with specific documentation linking them.  See the instructional note in Section I, part A - Conventions for the ICD-10-CM:
> 
> _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, 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 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.* _


Would the provider have to say the condition was *due to* diabetes or *caused by* the diabetes in order to establish a linkage? What if the provider lists in the assessment; Diabetes *associated with* *hyperlipidemia* and provides the code they have chosen E11.69 or  Diabetes _with_ Atherosclerosis of Aorta followed by their  chosen code.  By the provider saying 'with' or 'associated with' followed by the complication is that enough to support the linkage or should it be more clearly stated as due to or caused by? Thanks!


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## thomas7331 (Dec 17, 2020)

baroquecoder said:


> Would the provider have to say the condition was *due to* diabetes or *caused by* the diabetes in order to establish a linkage? What if the provider lists in the assessment; Diabetes *associated with* *hyperlipidemia* and provides the code they have chosen E11.69 or  Diabetes _with_ Atherosclerosis of Aorta followed by their  chosen code.  By the provider saying 'with' or 'associated with' followed by the complication is that enough to support the linkage or should it be more clearly stated as due to or caused by? Thanks!


The ICD-10 guidance is that a causal relationship is presumed when the word 'with' appears in the ICD-10 alphabetic index or tabular list, not when it appears in the medical record.  So I would not presume a relationship from the documentation example you give here.  'Associated with' should not be assumed to mean 'caused by', and neither hyperlipidemia nor atherosclerosis are linked to diabetes in ICD-10.


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