Home Health ICD-9/ICD-10 Alert

"With" doesn't necessarily indicate a cause-and-effect relationship.

When can you assume a condition is a manifestation of diabetes? What does it take to link hypertension and kidney disease? Put your coding skills to the test and demonstrate your mastery of relational terms with this quiz.

Relational terms in the alphabetic index such as "and," "due to," "with," "associated with," "without" and "in" are used to indicate relationships with a subterm, says Carol Spencer, RHIA, with the American Health Information Management Association (AHIMA) in Chicago.

Test your knowledge of relational term concepts before turning to page 22 for the answers.

Question 1: The physician wrote "Aspirate noted. Swallowing study ordered. Pneumonia." It's safe to code 507.0 (Pneumonitis due to inhalation of food or vomitus) for this patient. True or false?

Question 2: Five months ago, the physician indicated that your patient had hypertension. Now he's also been diagnosed with "chronic kidney disease." You don't need to query the physician to assume that the two are linked and to list a code from the 403.x (Hypertensive chronic kidney disease) category. True or false?

Question 3: The statements "with" and "mention of associated" are sufficient to indicate cause and effect. True or false?

Question 4: When you see two sets of codes, one in italics and brackets, next to a subterm in the alphabetic index, such as 250.7 [785.4], you should sequence the code in brackets first. True or false?

Answer to question 1: False. You can't say it's aspiration pneumonia, Spencer says. The physician's statement must indicate a causal relationship. For example, "pneumonia due to food (regurgitated)" indicates a causal relationship between two conditions.

Answer to question 2: True. If a patient has both hypertension and kidney disease, ICD-9 assumes that the two conditions are related and you can select a code from the 403 category, assigning a fifth digit to indicate the stage of the chronic kidney disease. Follow this with the code for the chronic kidney disease.

Answer to question 3: False. "With" and "mention of associated" don't necessarily reflect cause and effect. But if the doctor says "diagnosis with diabetes," such as diabetes with coma, complications or gangrene, you can link the two conditions as long as this is documented. This is the case where you would refer to the "with" entry below the main term in the alphabetic index.

Caution: The doctor must indicate both elements in the ICD-9 code title or you cannot code for them as a cause-and-effect relationship.

Exception: You can assume gangrene is caused by diabetes when the patient has both conditions, according to Coding Clinic.

Answer to question 4: False. Codes presented in this fashion indicate a manifestation paired with its underlying diagnosis. The ICD-9 code for the underlying disease should be listed first. With the example pairing listed in the question, 250.7x (Diabetes with peripheral circulatory disorders) comes first, followed by 785.4 (Gangrene). Manifestations should never be coded first.