Cracking the Code

Interpreting the “with” Guideline

Per coding guidelines, it is accurate to interpret the word “with” or “in” as “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note. Therefore, conditions that fall under this guideline have an assumed causal relationship and should be reported as related even if the provider does not specifically link the two conditions together. For example, diabetes and chronic kidney disease are two conditions that should be linked together unless a provider’s documentation clearly states that they are not related to one another. If a provider documents a patient having diabetes and chronic kidney disease, then a coder should report E11.22, diabetes with chronic kidney disease and N18.9, chronic kidney disease, unspecified. It is important for coders to understand this guideline pertaining to the word “with” in order to report diagnoses as accurately as possible and ensure clean claims before proceeding to billing.

Q: A patient is discharged home with the following final diagnoses: hypertension, type II diabetes, congestive heart failure, and stage III chronic kidney disease.
A: I13.0, hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease.
E11.22, diabetes with chronic kidney disease
I50.9, heart failure, unspecified
N18.3, chronic kidney disease, stage 3 (moderate)
Reference: ICD-10-CM Official Guidelines for Coding and Reporting FY 2022, Section I.A.15.
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