Did You Know? Coding Diabetes with Complications

In accordance with the ICD-10-CM guidelines, a causal relationship is assumed between diabetes mellitus (DM) and a documented condition when the term “with” is used. This terminology implies that the condition is associated with or due to diabetes. 

Example: 

Assumed Linkage 

When a provider documents treatment and support in the assessment and plan section of the encounter note, and the member has DM2, hypertension (HTN), chronic kidney disease (CKD), dementia, and atrial fibrillation (Afib), a causal relationship can be assumed between DM2 and CKD. In this case, assign diagnosis code E11.22. 

Common diabetes-related assumed linkages include: 

• Chronic Kidney Disease (CKD) 
• Neuropathy 
• Peripheral Arterial Disease (PAD) 
• Retinopathy 

Additional linked conditions can be found in the ICD-10-CM Index under Diabetes / with. 

Importantly, provider documentation does not need to explicitly state that the conditions are related in order to assign combination codes. However, if the provider clearly documents that the conditions are unrelated, the causal relationship must not be assumed, and the conditions should be coded separately. 

Example: 

Linkage Denied 

If provider documentation explicitly states that the patient’s diabetic condition is not related to their neuropathy, the causal relationship is not assumed. In this scenario, assign separate codes: 

• E11.9 for DM2 
• G62.9 for Neuropathy