New Guidance on the word “with” in ICD-10-CM Effective DOS 10/1/2016

Under new guidance from ICD-10-CM, the term “with,” when used in the Alphabetical Index, Tabular, or instructional notes, was only used by ICD-10-CM authors when two conditions are normally associated with one another clinically. This means that the provider does not need to demonstrate a cause and effect relationship whenever the word “with” is found in ICD-10-CM as a descriptor in the Alphabetical Index, Tabular, or instructional notes.

A. Conventions for the ICD-10-CM

15. “With”

The word “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. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetical Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states that the conditions are unrelated. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related.

This new directive establishes that throughout the Alphabetical Index, as well as the Tabular, and instructional notes, that whenever the word “with” is used to describe conditions, that when those conditions are present in the same date of service, that they should be coded as related, even in the absence of provider documentation explicitly linking them unless the provider explicitly states they are not related.

This is further reinforced with the following new excerpt on the coding of hypertension and heart disease and chronic kidney disease. Where we previously only linked Hypertension and CKD in ICD-9-CM, we now can assume the relationship between hypertension and heart involvement such as CHF.

Chapter 9: Diseases of the Circulatory System (I00-I99)

a. Hypertension

The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term “with” in the Alphabetic Index. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated.

For hypertension and conditions not specifically linked by relational terms such as “with,” “associated with,” or “due to” in the classification, provider documentation must link the conditions in order to code them as related.

 

Brian Boyce, BSHS, CPC, CPC-I, CRC, CTPRP is an AAPC-approved PMCC medical coding instructor, and ICD-10-CM trainer and the author of the AAPC CRC® curriculum. He has specialized in risk adjustment from the very beginnings of these models being utilized and has assisted large and small clients nationally. He has special interest in ethics, patient safety, disease management, and management and leadership of people. Brian is a veteran of Desert Storm, where he served on active duty with the US Air Force with a job specialty of Aeromedical Evacuation. He went into physician practice management and medical coding after an honorable discharge. He is the CEO of ionHealthcare®, LLC, a company that specializes in risk adjustment coding & support services. For additional inquiries contact ionHealthcare® at info@ionHealthcare.com.