Wiki Diabetes Assumed Relationships

[AmberDean]

How would you go about coding a scenario where the patient has both CHF and DM2, but the two conditions are NOT linked in the documentation.
We're being guided to code E11.59 along with the I50.XX, but I don't agree that the link can be made without the documentation to support it. Any guidance to a credible source for this would be greatly appreciated

 

[LisaAlonso23]

You may only code a condition as being a complication of DM if it's listed under DM in the ICD-10 index or the provider documents a relationship between the conditions.

 

[keke74]

You can refer to ICD-10 guidelines, Sec. I.A.15 which states that the term “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. 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 or when another guideline exists that specifically requires a documented linkage between two conditions.

For conditions not specifically linked by these relational terms 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.

Hope this helps!