# New description for coding convention "with"



## April Syth (Oct 26, 2016)

So I am finding that there is additional description for coding convention "with" "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." So my question if a patient has CKD and also has diabetes we can now assume the relationship and use the diabetic manifestation code E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease? Or does the provider has to say the term "with"? Or does the provider have to select the manifestation code? I am just wondering if the coders now have the ability to link the two conditions without the providers telling us? Thanks


----------



## ancoleman22 (Oct 26, 2016)

Yes, you may now assume that diabetes and CKD are linked without provider documentation stating so.

 If you look in the alpha index under diabetes, you will find "with" and then a variety of different items such as CKD, Neuropathy, etc. You are now able to assume a casual relationship between the two unless stated otherwise by the physician. 

For example, if you are reading along and they state the patient has diabetes and further down they state the patient also has CKD, you may now link the two unless the physician states otherwise. The same relationship is now assumed with HTN and Heart disease as well.


----------



## grothrock (Dec 14, 2016)

I am getting conflicting answers in regards to the sub-term link and other conditions for example if the pt has DM2 and HTN and DJD of multiple sites would they be linked? HTN falls within the circulatory system and one of the sub terms is circulatory complication E11.59 and there is not a note stating this only applies to PVD or PAD etc; and DJD is within the musculoskeletal system and then would be linked by DM with arthropathy E11.618 From what I have read DM can affect almost every body system so if there is a sub term listed for the other conditions/body system we should be linking them?


----------



## dukemell (Jan 22, 2017)

*General coding*



grothrock said:


> I am getting conflicting answers in regards to the sub-term link and other conditions for example if the pt has DM2 and HTN and DJD of multiple sites would they be linked? HTN falls within the circulatory system and one of the sub terms is circulatory complication E11.59 and there is not a note stating this only applies to PVD or PAD etc; and DJD is within the musculoskeletal system and then would be linked by DM with arthropathy E11.618 From what I have read DM can affect almost every body system so if there is a sub term listed for the other conditions/body system we should be linking them?



I would not combine HTN & DM or DJD without Dr. linking.   I would combine DM & the exact verbiage used under DM "with".  Ex; Type 2 DM & left foot ulcer E11.621.


----------

