Coding Diabetes Mellitus with Presumed Conditions

Diabetes is a systemic condition, meaning its presence has effects on organs and tissues throughout the body. These effects often lead to the patient developing another condition. Examples include retinopathy, angiopathy or nephropathy. Reporting diabetes in conjunction with associated conditions can be a challenge for coders. Fortunately, ICD-10-CM provides the “With” convention that helps direct the coding process. The “With” convention states:

Based on the direction of the “With” convention, ICD-10-CM presumes a causal relationship between diabetes and multiple common conditions that are linked to diabetes by the subterm “with” in the Alphabetic Index.

Here’s a list of the conditions where the causal relationship with diabetes is presumed in ICD-10-CM:

• amyotrophy
• arthropathy NEC
• autonomic (poly) neuropathy
• cataract
• Charcot’s joints
• chronic kidney disease
• circulatory complication NEC
• coma due to hyperosmolarity, hypoglycemia, ketoacidosis
• complication specified NEC
• dermatitis
• foot ulcer
• gangrene
• gastroparalysis
• gastroparesis
• glomerulonephrosis, intracapillary
• glomerulosclerosis, intercapillary
• hyperglycemia
• hyperosmolarity without coma
  • with coma
• hypoglycemia without coma
  • with coma
• ketoacidosis without coma
  • with coma
• kidney complications NEC
• Kimmelsteil-Wilson disease
• loss of protective sensation(LOPS) – see Diabetes, by type, with neuropathy
• mononeuropathy
• myasthenia
• necrobiosis lipoidica
• nephropathy
• neuralgia
• neurologic complication NEC
• neuropathic arthropathy
• neuropathy
• ophthalmic complication NEC
• oral complication NEC
• osteomyelitis
• periodontal disease
• peripheral angiopathy without gangrene
  • with gangrene
• polyneuropathy
• renal complication NEC
• renal tubular degeneration
• retinopathy without macular edema
  • with macular edema
    • with macular edema resolved following treatment
• retinopathy nonproliferative, unspecified, mild, moderate or severe without macular edema
  • with macular edema
• retinopathy proliferative with
  • combined traction retinal detachment and rhegmatogenous retinal detachment
  • macular edema
  • stable proliferative diabetic retinopathy
  • traction retinal detachment involving the macula
  • traction retinal detachment not involving the macula
• skin complication NEC
• skin ulcer NEC

If the documentation states that a condition routinely associated with diabetes is due to a different etiology, DO NOT also presume a causal relationship with diabetes and DO NOT code as a diabetic complication.

If coders are unsure about whether a specific condition is due to or “with” diabetes, consult the Alphabetic Index for the subterm “diabetic” under the main term entries for the associated condition.

Example: A patient has diagnoses of diabetes and amyotrophy. Under the main term Diabetes, amyotrophy is listed under the “with” subterm.

The recommended code is E11.44 Type 2 diabetes mellitus with diabetic amyotrophy

Diabetes, diabetic (mellitus) (sugar) E11.9

- with

- - amyotrophy E11.44

A search under the main term Amyotrophy and the subterm diabetic confirms the validity of the initial search as it directs the coder back to the main term Diabetes and the subterm amyotrophy.

Amyotrophia, amyotrophy, amyotrophic G71.8

- congenita Q79.8

- diabetic -see Diabetes, amyotrophy

- lateral sclerosis G12.21

- neuralgic G54.5

- spinal progressive G12.25

Coders are encouraged to also consult official coding guidance such as AHA Coding Clinic to review direction for applying the “With” convention to specific instances of diabetes with associated conditions.

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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.