Wiki Diabetes complicated by

[mcdream]

Hi all! Input please

Provider documented: T2DM complicated by coronary artery disease, Congestive heart failure, chronic kidney disease and peripheral neuropathy.

In the Alpha Index there is not a sub-entry under diabetes>"with" for CAD or CHF to assume a causal relationship. However, because the provider stated "complicated by" CAD, CHF would the appropriate codes be:
E11.69 (NEC)- w/other specified complication (referring to CAD & CHF)
*Use additional code to identify complication
I25.10- atherosclerotic heart disease of native coronary artery w/o angina pectoris/coronary (artery) disease
I50.9- heart failure, unspec/congestive heart failure NOS
E11.22- diabetic chronic kidney disease (stage not documented- is there a code for unspecified stage...N18.9?)
E11.42- diabetic polyneuropathy (synonymous of peripheral neuropathy)


Seperate question #1: Documentation states "T2DM under poor control" would you code as E11.65-DM w/hyperglycemia or E11.9-DM w/o complication?
Does "poor control" mean the same as "poorly controlled"?
Alpha Index classifies "poorly controlled DM" as "DM with hyperglycemia"

Seperate Question #2: If documentation states "T2DM with evidence of hyperglycemia" in the outpatient record can you code "evidence of" as definitive diagnosis; E11.65-DM w/hyperglycemia

TIA

 

[thomas7331]

Just my opinions here, but for what they're worth:

'Complicated by' does not mean 'caused by', so I would not assign E11.69 here.

'Poor control' and 'poorly conrolled', on the other hand, have identical meaning, just different grammatical structure, so I would interpret these to be equal.

For 'evidence of', I would consider this an uncertain diagnosis, so would not code the complication unless the provider actually decides to make the diagnosis based on that evidence (i.e. in a trial, there may be evidence that a criminal is guilty, but they aren't actually guilty until the jury decides it.)

 

[thomas7331]

Hi Thomas- thank you for your reply.
I agree, "complicated by" doesn't mean "caused by".
When looking at section 1 of the guidelines, the "with" instruction (convention No. 15)- "The word with" should be interpreted to mean "associated with"..."
Question/seeking input: does "complicated by" mean the same as "associated with"?

TIA

You're welcome!

'Complicated by' does not mean 'associated with', but in this context it doesn't matter for coding purposes. Whenever 'with' or 'in' appears in the ICD-10, you will assign that code that it directs you to whenever the provider documents in the same record that both of the conditions exist, regardless of the language linking them. As the guidelines say, if these terms appear in the index or list, the causal relationship between the two is presumed unless the provider specifically documents that the two are unrelated.

 

[mcdream]

You're welcome!

'Complicated by' does not mean 'associated with', but in this context it doesn't matter for coding purposes. Whenever 'with' or 'in' appears in the ICD-10, you will assign that code that it directs you to whenever the provider documents in the same record that both of the conditions exist, regardless of the language linking them. As the guidelines say, if these terms appear in the index or list, the causal relationship between the two is presumed unless the provider specifically documents that the two are unrelated.

Thank you Thomas- your explanation is fantastic!
'Complicated by' does not mean 'associated with'.
Therefore, cannot presume causal relationship.
So in this example code I25.10 & I50.9 and don't code E11.69.
Thanks again, I appreciate your help!

 

[sconnell08]

Good afternoon,

First of all, great questions! In regards to your first question about "complicated by", it would be beneficial to reach out to that provider for further clarification to see if the diabetes is a contributing factor to the diseases you presented in this case or if they are a complication of diabetes. Secondly, when it comes to poorly controlled, I agree with Thomas in that they synonymous with one another. As for your last question, Coding Clinic came out with a statement (1Q 2014: pg.18) regarding "evidence of" in the ambulatory (outpatient) setting and stated that "it is not considered an uncertain diagnosis and should be appropriately coded and reported in the outpatient setting." I hope this answers your questions. Let me know if you need me to clarify anything further or if you have any other questions. Have a great weekend!

 

[thomas7331]

Thank you Schuyler, that's a Coding Clinic guidance I hadn't encountered before, or if I had, must have forgotten. (Not sure if I agree with it, but then again, I'd defer to them as they're the experts.) Always something new to learn in this business!

 

[sconnell08]

Thank you Schuyler, that's a Coding Clinic guidance I hadn't encountered before, or if I had, must have forgotten. (Not sure if I agree with it, but then again, I'd defer to them as they're the experts.) Always something new to learn in this business!

You're welcome, Thomas. I know what you mean. In my opinion, if there is evidence of a condition, why would a provider state "evidence of" hyperglycemia rather than just stating that they have the condition. The providers that I have spoken with always state that a patient has a specific condition and never uses that statement. Granted, if it is a working condition, they may use "consistent with" but it does depend on the setting (IP/OP).

 

[mcdream]

You're welcome, Thomas. I know what you mean. In my opinion, if there is evidence of a condition, why would a provider state "evidence of" hyperglycemia rather than just stating that they have the condition. The providers that I have spoken with always state that a patient has a specific condition and never uses that statement. Granted, if it is a working condition, they may use "consistent with" but it does depend on the setting (IP/OP).
[/QUOTE

Good afternoon,

First of all, great questions! In regards to your first question about "complicated by", it would be beneficial to reach out to that provider for further clarification to see if the diabetes is a contributing factor to the diseases you presented in this case or if they are a complication of diabetes. Secondly, when it comes to poorly controlled, I agree with Thomas in that they synonymous with one another. As for your last question, Coding Clinic came out with a statement (1Q 2014: pg.18) regarding "evidence of" in the ambulatory (outpatient) setting and stated that "it is not considered an uncertain diagnosis and should be appropriately coded and reported in the outpatient setting." I hope this answers your questions. Let me know if you need me to clarify anything further or if you have any other questions. Have a great weekend!

Thank you Sconnell- If I understand your explanation...
If diabetes is a 'contributing factor' to CAD, CHF then don't code E11.69, only code I25.10 & I50.9?
But
If CAD, CHF are 'complications of' diabetes then do code E11.69 along with I 25.10 & I50.9?

*The 'with' convention has me questioning. The convention states can presume causal relationship without provider explicitly linking two conditions. Alpha index-diabetes-with-chronic kidney disease. In the case sample above would E11.22 be appropriate or is N18.9 the appropriate code?
TIA

 

[sconnell08]

Basically, you would be seeking clarification by the provider regarding what they meant by "complicated by." For example, is their CKD associated with or due to their diabetes? Or does the patient have the two conditions but they are not associated with one another.