In the Alphabetic Index of ICD-10-CM, when indexing diabetes there is an entry under “with” for skin complications NEC. This has brought up many question over the past year regarding coding of cellulitis in patients that also have a diagnosis of diabetes. Are these two linked by the definition of “with” in ICD-10-CM?
Finally, there is official guidance on this subject.
NO, the link is not assumed when patients have cellulitis and diabetes documented. The physician would need to document the cellulitis as a diabetic skin complication or link the two conditions with verbiage such as “due to”, “associated with” or similar terms. If the documentation is not clear and the coder is unable to determine whether a condition is a diabetic compilation and/or the ICD-10-CM classification does not provide instruction, it would be appropriate to query the physician for clarification.
Even though there is an entry under “with” for skin complication right after the main term of diabetes, there is not an entry for cellulitis. Per the 4Q2017 AHA Coding Clinic, the “with” guideline does not apply to NEC (not elsewhere classified) conditions. Only specific conditions would be linked by these terms. If this were the case, then any skin issue would be considered as a diabetic complication when patients have both a skin condition documented and diabetes. An obvious example of this would be a patient with diabetes and also acne. Most likely the acne is not a complication of the diabetes but of puberty or other skin disorder.
“With”
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, 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”). ICD-10-CM Official Guidelines for Coding and Reporting FY 2018 Page 13 of 117
For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related.
The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.
Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P
References:
AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, Fourth Quarter 2017 Page: 100-101
ICD-10-CM Official Guidelines for Coding and Reporting FY 2018 Page: 12-13
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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.