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.
Hello!
Per the ICD-10-CM Coding Guidelines “The word “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 (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).”
According to the “with” guideline above, we can link certain conditions for DM with complications; however, per Coding Clinic (2018, Issue 2), the “With” Guideline does not apply to “not elsewhere classified (NEC)” index entries that cover broad categories of conditions. Specific conditions must be linked by the terms “with,” “due to” or “associated with.” So, your question regarding diabetes and a specific type of glaucoma being linked without the provider linking the glaucoma to the diabetes, we would not be able to link glaucoma to diabetes since code E11.39 (ophthalmic complication NEC) is a NCE code. However, if the patient were to have cataracts and diabetes and the provider did not link the two conditions and the cataracts was not documented as being due to another condition, then you would be able to link the cataracts to the diabetes since code E11.36 (Type 2 diabetes mellitus with diabetic cataract) is not a NCE code.
Here is a little tip I did when I first started out in HCC coding, which helped me. In my ICD-10-CM book, for example, in the Alphabetical Index under Diabetes/ with, I highlighted all the codes under the subterm “with” that were NCE codes which let me know those codes required the provider to link the condition to the diabetes. So, for example, arthropathy NEC E11.618, circulatory complication NEC E11.59, E11.39 ophthalmic complication NEC, etc., I highlighted.