Wiki HCC query diabetes and its complication

[siddharthaqa@rediffmail.com]

Please let me know can we code a combination code for diabetes and its complications if linkage is not mentioned in the medical report?

For example, if the patient has diabetes and specific type of glaucoma and we get MEAT for both of them, can we code E11.39 (Type 2 diabetes mellitus with other diabetic ophthalmic complication) and code for glaucoma with diabetes complication dx.

Also, can we assume causal relationship between diabetes and its complication even if the linkage (with or due to) is not mentioned in the medical report by the physician and code a combination dx if we get MEAT for both the diagnoses code?

Thank you in advance.

 

[renee dustman]

Does this help? Per AHA ICD-10-CM Coding Clinic 2016 Vol 3 No 2:
The subterm “with” in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word “with.” The physician documentation does not need to provide a link between the diagnoses of diabetes and chronic kidney disease to accurately assign code E11.22, Type 2 diabetes mellitus with diabetic chronic kidney disease. This link can be assumed since the chronic kidney disease is listed under the subterm “with.” 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 and due to some other underlying cause besides diabetes. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related.”

 

[sls314]

Please let me know can we code a combination code for diabetes and its complications if linkage is not mentioned in the medical report?

For example, if the patient has diabetes and specific type of glaucoma and we get MEAT for both of them, can we code E11.39 (Type 2 diabetes mellitus with other diabetic ophthalmic complication) and code for glaucoma with diabetes complication dx.

Also, can we assume causal relationship between diabetes and its complication even if the linkage (with or due to) is not mentioned in the medical report by the physician and code a combination dx if we get MEAT for both the diagnoses code?

Thank you in advance.

For the scenario you specifically mentioned, you'd want the provider to specifically link the 2 conditions.

With a condition that is specifically named under the "with" you don't need linkage. For example, Diabetes with CKD, Diabetes with neuropathy, etc

However, for something that you're trying to connect as an "other" complication, the provider should specifically document the connection between the two.

Glaucoma is not specifically listed as a diagnosis that can be linked under the "with." To consider it an "other ophthalmic complication," the provider should specifically state that the glaucoma is related to the patient's diabetes.

 

[siddharthaqa@rediffmail.com]

Does this help? Per AHA ICD-10-CM Coding Clinic 2016 Vol 3 No 2:
The subterm “with” in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word “with.” The physician documentation does not need to provide a link between the diagnoses of diabetes and chronic kidney disease to accurately assign code E11.22, Type 2 diabetes mellitus with diabetic chronic kidney disease. This link can be assumed since the chronic kidney disease is listed under the subterm “with.” 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 and due to some other underlying cause besides diabetes. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related.”

Thank you, very helpful

 

[siddharthaqa@rediffmail.com]

For the scenario you specifically mentioned, you'd want the provider to specifically link the 2 conditions.

With a condition that is specifically named under the "with" you don't need linkage. For example, Diabetes with CKD, Diabetes with neuropathy, etc

However, for something that you're trying to connect as an "other" complication, the provider should specifically document the connection between the two.

Glaucoma is not specifically listed as a diagnosis that can be linked under the "with." To consider it an "other ophthalmic complication," the provider should specifically state that the glaucoma is related to the patient's diabetes.

Thank you, very helpful information