New ICD-10 Guidelines for the Term “With”

New ICD-10 Guidelines for the Term “With”

  • 28 Mar Off
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by Katina Yablinsky, CRN-C

In October 2016, there was an update to the ICD-10 coding guidelines that allows a coder more flexibility in assigning certain codes. Previously, the guidelines stipulated that if two conditions are related to each other, the provider needs to document their relationship for them to be coded as such.

A common example is relating a patient’s polyneuropathy to their diabetes. We still consider best practice, clinically, to link related conditions together in the documentation. However, the ICD-10 coding guidelines now indicate that if a manifestation listed under “with” in the index, is documented as part of the same encounter the coder can assume their relationship despite no documented linkage.

The 2016 ICD-10 Guidelines state that the term “with” 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. This means a causal relationship is presumed between

Katina Yablinsky, CRN-C Risk Adjustment and   Coding Specialist

the two conditions linked by ‘with.’ The conditions should be coded as related even in the absence of the provider linkage, unless the provider clearly states that the conditions are unrelated.

For example, a provider documents that the participant has alcohol abuse and later in the same encounter documents a diagnosis of anxiety. Per the Guidelines, the coder will link these two conditions together and code this as F10.180 (Alcohol Abuse with Alcohol-induced Anxiety Disorder) which falls to HCC 55 Drug/Alcohol Dependence. Prior to the ICD-10 guideline changes the anxiety and alcohol abuse would have been two codes (F10.10 and F41.9) and F10.10 wouldn’t map to Alcohol Dependence, HCC 55.

We still believe, and educate, that if there is an association between two diagnoses, the provider should show that connection in their documentation. This is good clinical medicine and allows complete documentation to the highest specificity. However, it is important to understand that moving forward, a coder may link two conditions that the ICD-10 classification has linked by the word “with” unless the provider specifically documents the two conditions are not connected.