ICD-10-CM and the Gift of “With” Confirmed!

ICD-10-CM and the Gift of “With” Confirmed!

by Angela Lehoux, BS, CDIP, CCS, CIC, CPC-I

In the fourth quarter 2016 Coding Clinic I was excited to see the question about osteomyelitis and diabetes being posed.

First, a little history. There was advice provided in the fourth quarter 2013 Coding Clinic that osteomyelitis should not be coded to a diabetic complication unless the provider clearly documented a linkage between the two conditions. The question posed in fourth quarter 2016 Coding Clinic was whether or not that advice is still applicable. Coding Clinic explains that the advice from 2013 is now obsolete and the index was updated in 2016 to reflect osteomyelitis as a term to be associated with diabetes unless the provider states otherwise.

The ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 states that the subterm “with” when found in the Index should be interpreted to mean “associated with” or “dueto.” The guideline goes on to state that a causal relationship is presumed and should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation states the conditions are unrelated.

The gift of “with” indeed! So, be sure to familiarize yourself with those “with” terms in your index. You may be surprised as you go through it how many gifts you find. Diabetes is not the only one; have a look at hypertension.

Happy coding!

About the Author

Angela Lehoux, BS, CDIP, CCS, CIC, CPC-I
With over 25 years of experience in inpatient, outpatient and emergency room coding, Angela is an Education Specialist, Instructor and Director of Education for Libman Education. Angela teaches Libman Education’s Medical Coder Career Program (MCCP), courses on ICD-10-CM and ICD-10-PCS, and courses for the CCA, CCS, CIC, and COC credentials. Angela holds a bachelor’s degree in Healthcare Management, Certified Coding Specialist, Certified Documentation Improvement Practitioner from AHIMA, Certified Inpatient & Outpatient Coder and the Certified Professional Coder Instructor certifications from AAPC.

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