Primary Care Coding Alert

Question: If a provider documents hypertension with diabetes mellitus, can I assume, and interpret, that “with” means the same as “associated with” or “due to?”

AAPC Forum Participant

Answer: You can find the answer to this question in ICD-10 guideline I.A.15, which states that “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 (either under a main term or subterm), or an instructional note in the Tabular List.”

If you look up “hypertension” in the ICD-10 Alphabetic Index, you will not find an entry for hypertension “with diabetes,” which would otherwise be “sequenced immediately following the main term or subterm” per the guideline. Likewise, if you look up “diabetes” in the Alphabetic Index, you will not find an entry for diabetes “with hypertension.”

Per guideline I.A.15, “For conditions not specifically linked by these relational terms [i.e., “with” or “in”] 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.”

In other words, in the absence of provider documentation that the hypertension is associated with or due to the diabetes, you cannot assume that relationship simply because the provider uses the word “with.” Instead, you will need to document the hypertension and diabetes with separate codes appropriate to each, such as I10 (Essential (primary) hypertension) for the hypertension and E11.9 (Type 2 diabetes mellitus without complications).