Wiki DM w/ HTN

[cmedina969800]

Hey fellow coders!

We recently had a visit from a document trainer/coder from Optum, and she mentioned that if a patient has DM w/ HTN should be coded as E11.59 and I10.

Is everyone doing this?

What are your thoughts?

 

[blaza192]

The ICD-10-CM classifies all "I" codes as circulatory diseases. E11.59 is the code for Type 2 diabetes mellitus with other circulatory complications, so it makes sense. You can't make the assumed relationship for diabetes and hypertension though, which I assume you know.




In audits I see, coder's use either E11.59 or E11.69. I would personally go with E11.59.

 

[cmedina969800]

The ICD-10-CM classifies all "I" codes as circulatory diseases. E11.59 is the code for Type 2 diabetes mellitus with other circulatory complications, so it makes sense. You can't make the assumed relationship for diabetes and hypertension though, which I assume you know.




In audits I see, coder's use either E11.59 or E11.69. I would personally go with E11.59.

Thank you for the response! It is greatly appreciated. I would like to verify the last part. My understanding with the newer guidelines is that IF the index says "with" it is now presumed that they are linked even if the provider does not state so in the documentation. Would that be fair to say that this would fall in that category?

 

[blaza192]

You are correct. If the term falls under "with" in the index, we can apply an assumed relationship; however, hypertension is not under "with" for diabetes.



Go to diabetes and then with. You'll see all the conditions there where assumed relationship can apply with some exceptions.

 

[OregonCindi]

HTN is "other circulatory"

You are correct. If the term falls under "with" in the index, we can apply an assumed relationship; however, hypertension is not under "with" for diabetes.


I understand where both of you are coming from, but I keep going back to the fact that "Other circulatory complications" IS under "with" for diabetes, and hypertension is a circulatory disease. Therefore, E11.59 includes hypertension.....

Cindi, CPC-A

 

[blaza192]

You are correct. If the term falls under "with" in the index, we can apply an assumed relationship; however, hypertension is not under "with" for diabetes.


I understand where both of you are coming from, but I keep going back to the fact that "Other circulatory complications" IS under "with" for diabetes, and hypertension is a circulatory disease. Therefore, E11.59 includes hypertension.....

Cindi, CPC-A

Luckily, this was clarified by the coding clinic: http://www.hiacode.com/education/codingtips/coding-tip-cellulitis-and-dm-coding/


Anything with an NEC under "with" does NOT have an assumed relationship.

arthropathy NEC
circulatory complication NEC
circulatory complication NEC
kidney complications NEC
neurologic complication NEC
ophthalmic complication NEC
oral complication NEC
renal complication NEC
skin complication NEC
skin ulcer NEC

I think that's all of it with the NEC. So, we can't assume that every single opthalmic complication or any of the other ones has an assumed relationship to diabetes. The specific condition has to fall under "with" to be linked.

It looks like they did not put an NEC on periodontal disease though.

Hope that helps.

 

[OregonCindi]

Thank you for that link; somehow I missed that article in my research prior to posting, but that is the information I was looking for and I wanted to see it in writing. ICD-10 is saying that IF the doctor links DM and a circulatory disease other than angiopathy, then E11.59 is where it would go.

Lol on the periodontal disease btw point taken.

Cindi, CPC-A

 

[cmedina969800]

Luckily, this was clarified by the coding clinic: http://www.hiacode.com/education/codingtips/coding-tip-cellulitis-and-dm-coding/


Anything with an NEC under "with" does NOT have an assumed relationship.

arthropathy NEC
circulatory complication NEC
circulatory complication NEC
kidney complications NEC
neurologic complication NEC
ophthalmic complication NEC
oral complication NEC
renal complication NEC
skin complication NEC
skin ulcer NEC

I think that's all of it with the NEC. So, we can't assume that every single opthalmic complication or any of the other ones has an assumed relationship to diabetes. The specific condition has to fall under "with" to be linked.

It looks like they did not put an NEC on periodontal disease though.

Hope that helps.

Thank you both for responding. It is really appreciated.

On a side note: Boy, you would think we should have a linkage between DM and HTN since they do affect and complicate one another. Maybe there will be a combo code for that in the future? LOL