Wiki Secondary hypertesion

[lilleyea]

Does anyone know the requirements to report secondary hypertension or secondary diabetes? I am reviewing charges for a weight loss surgeon where the patient has morbid obesity and other comorbidities. The documentation simply states "morbid obesity, BMI of 38, with significant comorbid conditions including DM2, HTN. The coder has coded the hypertension and diabetes as secondary conditions (I15.9 & E13.8), however I have found no documentation in the medical record stating that the conditions are due to the morbid obesity. I have reviewed the coding guidelines for "with" however it appears to only apply to ICD-10 book code titles, alphabetic index, or instructional note in the tabular list, not to the provider's documentation. Does anyone have more clarity on this? I can't find anything regarding coding secondary conditions besides that they are due to an underlying condition. Does the provider have to specifically state hypertension due to obesity; or diabetes due to obesity in order to code secondary diabetes and secondary hypertension? Thanks for any and all answers.

 

[rhondatalley]

morbid obesity with diabetes and hypertension

Unless the provider documents that the diabetes or the hypertension is due to or caused by the morbid obesity, the statement of comorbid conditions, in my opinion, would not reported as secondary hypertension or secondary diabetes.

According to the CDC:

Comorbidity means more than one disease or condition is present in the same person at the same time. Conditions described as comorbidities are often chronic or long-term conditions. Other names to describe comorbid conditions are coexisting or co-occurring conditions and sometimes also “multimorbidity” or “multiple chronic conditions.”

Per the "with" convention in the ICD-10-CM Official Guidelines and review of the index and tabular entries for obesity, there is not an assumed link between obesity and diabetes or hypertension.