# DM & Hyperlipidemia



## millbj (Oct 26, 2017)

Question:  How is everyone coding DM and Hyperlipidemia.  Are you coding them separate as E11.9 & then E78.2 (if it's mixed) or are you coding them as E11.69 & then the E78.2.

Most providers are just stating pt has DM  then they state pt has Hyperlipidemia. 

I find conflicting info as to whether you can code as the E11.69 for DM w/ other complication or if you should not.

How is everyone else out there in the coding world handling this?

Txs


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## mitchellde (Oct 26, 2017)

Using your code book, go to the alpha index and look for key word diabetes .  Under diabetes you see the word with.  Indented under the word with are numerous entries.  Each entry under the word with is automatically causal to the diabetes and does not need to be documented as causal by the provider.  If it is not in that list then to be a manifestation of the diabetes the provider would need to document that it is.


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## coderexcellence (Apr 23, 2018)

*E11.69*

Diabetes with specified complication E11.69--If DM and HLP are documented in the note, is that considered enough linkage? Still trying to understand. 
Thank you for any help!


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## thomas7331 (Apr 23, 2018)

coderexcellence said:


> Diabetes with specified complication E11.69--If DM and HLP are documented in the note, is that considered enough linkage? Still trying to understand.
> Thank you for any help!



If it's not documented as a complication caused by the diabetes, then you can't code it as a complication unless the code book directs you to it through a 'with' entry in the index, as Debra describes above.  

If you refer to the very beginning of the ICD-10 book, under "Section I. Conventions, general coding guidelines and chapter specific guidelines", it spells this out:  _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...._ 

So only in the cases listed under 'with' can you code the condition as a complication in the absence of documentation stating that.  In your example, since hyperlipidemia does not appear listed under diabetes as an option after 'with', you cannot presume the causal relationship, and it cannot be coded as a complication of diabetes unless the provider has documented that the diabetes caused that condition.


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## coderexcellence (Apr 24, 2018)

*Thank you.*

Thank you Thomas. That clarifies it.


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## momo2 (May 3, 2018)

*Diabetes and the word "and" instead of "with"*

Hello,

Just having a conversation with a co-worker and we are trying to determine if a Provider documents Diabetes type 2 "and" PVD, should it be coded as E11.9 and I73.9.

I know from reading the AAPC monthly magazine that if the Provider stated 

1. Diabetes type 2 - continue meds
2. PVD - continue meds

that since PVD appears under the subterm "with", there is a causal relationship and can be coded using a combination code.

Just need to clear up if provider uses the term "and" to delineate between the two dx codes.

Thanks!!


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