I've come across the Coding Clinic 2017 4Q pg 100-1 that address the NEC conditions listed under the 'with' for Diabetes. It states;
'The "with" guideline does not apply to "not elsewhere classified (NEC)" index entries that cover broad categories of conditions. Specific conditions must be linked by the terms "with," "due to" or "associated with". Coding professionals should not assume a causal relationship when the diabetic complication is "NEC".
![4187 4187](https://www.aapc.com/discuss/data/attachments/3/3299-4b8af2843f877caa1ea86b1f3ecb31be.jpg)
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![4188 4188](https://www.aapc.com/discuss/data/attachments/3/3300-fd4ba7174b3938ff9aa5532fed514179.jpg)
So my question is, a patient has diabetes and a ulcer is documented (not on foot) and MD did not state they are together. These two conditions cannot be linked because in the index, under 'with' the 'skin ulcer' has a NEC. Do you agree they should not be linked or do most people link them?
I've never been instructed about the NEC rule and unfortunately I was under the impression that you could link any ulcer with diabetes.
'The "with" guideline does not apply to "not elsewhere classified (NEC)" index entries that cover broad categories of conditions. Specific conditions must be linked by the terms "with," "due to" or "associated with". Coding professionals should not assume a causal relationship when the diabetic complication is "NEC".
![4187 4187](https://www.aapc.com/discuss/data/attachments/3/3299-4b8af2843f877caa1ea86b1f3ecb31be.jpg)
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![4188 4188](https://www.aapc.com/discuss/data/attachments/3/3300-fd4ba7174b3938ff9aa5532fed514179.jpg)
So my question is, a patient has diabetes and a ulcer is documented (not on foot) and MD did not state they are together. These two conditions cannot be linked because in the index, under 'with' the 'skin ulcer' has a NEC. Do you agree they should not be linked or do most people link them?
I've never been instructed about the NEC rule and unfortunately I was under the impression that you could link any ulcer with diabetes.