Improving Coding for Hypertension Associated with Diabetes

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Improving Coding for Hypertension Associated with
Diabetes
Basics of Coding for Hypertension Associated with
Diabetes Most coders are still confused about
which is the correct code for hypertension
associated with diabetes. If you look carefully,
hypertension is not listed as a specified
complication. Hypertension is considered a
circulatory complication so the correct code
could be E11.59 rather than the more unspecified
code of E11. 69 (other specified complication).
We can also refer, an audit report by Humana
where it was indicated that diabetes and
hypertension have an assumed relationship and it
should be coded as E11.59 (for type 2
diabetic.) Coding Hypertension and Diabetes
Separately Some coders mention code as I10 for
hypertension and E11.9 for diabetes. As diabetes
is not always associated with hypertension, one
should read provider documentation clearly and
code it accordingly. Diabetes is documented and
supported with a complication of Hypertension.
You can also refer few guidelines for this
approach. If the provider has only documented
diabetes with hypertension, then you would not
presume a causal relationship between the two
because the two terms diabetes and
hypertension as these are not linked
in ICD-10 by the term with..
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Improving Coding for Hypertension Associated with
Diabetes
If the provider has specifically documented that
the hypertension was caused by diabetes, then you
would code hypertension as a circulatory
complication. Only the terms listed in the index
under diabetes with should be coded as a
complication with specific documentation linking
them 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. 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. For more information,
you can also refer to Coding Clinic 4th QTR 2017
and 2nd 2018 (AHIMA document). In order to assume
a with connection, the specific condition must
be listed in the alphabetic index or tabular
list. NEC conditions are not assumed to be
related. In our current assumption, hypertension
is not specifically listed as an assumed diabetic
complication so the code for diabetes with other
circulatory conditions should not be assigned.
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Improving Coding for Hypertension Associated with
Diabetes
The exception to this would be if the
documentation specifically makes the connection,
hypertension due to diabetes. Diabetes and
hypertension are not presumed to be related
unless the provider specifically documents that
it is. An example of assuming the connection
would be if the patient is diagnosed with both
Diabetes and Retinopathy. In that case, the
connection is assumed and the appropriate
combination code would be assigned. Diagnosis
Coding Example Lets refer to one coding example
from JustCoding on reporting diabetes, Chronic
Kidney Disease (CKD), and Hypertension (HTN) in
ICD-10-CM. Example We had a patient with Type 2
diabetes who was admitted for hypoglycemia with
metabolic encephalopathy. The patient also had
stage 2 chronic kidney disease (CKD) and a
diagnosis of hypertension (HTN). Which ICD-10-CM
codes should we assign for this patients
encounter? ICD-10-CM assumes a cause-and-effect
relationship between CKD and HTN, as well as CKD
and diabetes. CKD is most likely related to both
HTN and diabetes when all three conditions are
present.
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Improving Coding for Hypertension Associated with
Diabetes

• High blood pressure and high blood sugar in the
  blood vessels can lead to the deterioration of
  the vessels, which can then cause damage to the
  kidneys. CKD should not be assigned as
  hypertensive if the providers documentation
  specifies that the CKD is not related to
  hypertension. Always query if the physicians
  documentation seems unclear, but based on the
  information given, I would report the following
  ICD-10-CM codes for this patients encounter
• 649, Type 2 diabetes mellitus with hypoglycemia
  without coma
• 41, metabolic encephalopathy
• 22, Type 2 diabetes mellitus with diabetic CKD
• 9, hypertensive CKD with stage 1 through 4 CKD,
  or unspecified CKD
• 2, CKD, stage 2 (mild)
• Medical Billers and Coders (MBC) is a leading
  medical billing company providing complete
  medical billing and coding services. You can
  refer payer specific coding guidelines for
  accurately coding for hypertension associated
  with diabetes. In case any assistance needed in
  medical billing and coding for your practice,
  email us at info_at_medicalbillersandcoders.com or
  call us 888-357-3226.