Coding Diabetes Mellitus with Assumed Conditions

Diabetes continues to be a challenge for coders since the new instruction/guideline was released in AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, First Quarter 2016. This became effective with March 18, 2016 discharges.

ICD-10-CM does assume the link between diabetes and multiple common conditions. In the past, these were not assumed and only coded as related to diabetes when clearly documented or queried by the coder for further clarification.

In the index of ICD-10-CM you will see several assumed conditions. Please continue to familiarize yourself with these so when you are coding the records you will know they are assumed conditions.

Here’s a list of the associated diabetic conditions where the link is assumed 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 with coma

hypoglycemia with coma

ketoacidosis 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 with gangrene

polyneuropathy

renal complication NEC

renal tubular degeneration

retinopathy with macular edema or resolved following treatment

retinopathy nonproliferative with macular edema (mild, moderate, or severe) retinopathy proliferative with combined traction retinal detachment and rhegmatogenous retinal detachment, macular edema, stable proliferative diabetic retinopathy, traction retinal detachment involving the macula, and traction retinal detachment not involving the macula

skin complication NEC

skin ulcer NEC

If the MD documents another etiology for the condition DO NOT code to a diabetic complication or assume the link with diabetes.

If unsure about a specific condition being due to or “with” diabetes, coders can look the condition up in the ICD-10-CM Index. All the above associated diabetic conditions will have an entry for “diabetic.” If you search those terms.

Example 1:

Patient has documented diabetes as well as a diagnosis of amyotrophy. neuralgia. Under the term for diabetes, amyotrophy is listed under the “with” subterm. Now look under the main term amyotrophy and there is a subterm for diabetic.

Example 2:

Patient has documented hypertension and diabetes. This would not be an assumed link using the term “with.” Hypertension is a circulatory issue but the entry for circulatory complication also includes NEC. This means that the condition is not elsewhere classified within ICD-10 which is not the case for hypertension.

Clarification of link of diabetes and osteomyelitis was published in the 4Q2016 AHA Coding Clinic.

Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P

References:

AHA Coding Clinic for ICD-10/PCS, First Quarter 2021: Page 7
AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, First Quarter 2016 Pages: 6-7
AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS, Fourth Quarter 2016
ICD-10-CM Official Guidelines for Coding and Reporting FY 2019 Pages 12-13
AHA Coding Clinic for ICD-10-CM/PCS, Second Quarter 2018 Pages: 6-7
AHA Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2018 Pages: 100-101
AHA Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2016 Pages: 11-13 and 141-143
AHA Coding Clinic for ICD-10-CM/PCS, Second Quarter 2016 Pages: 36-37