Coding Diabetes Mellitus with Presumed Conditions

Written by Cari Greenwood, RHIA, CCS, CPC | Jan 22, 2025 5:15:00 AM

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:

"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 (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…”

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.

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