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Coding Tip of the Month – June 2018

When coding a patient with DM and peripheral angiopathy, peripheral vascular disease or peripheral arterial disease, assume a link between the two conditions unless the provider has linked the peripheral angiopathy to another underlying condition. Because atherosclerosis is a speciic type of peripheral angiopathy use an additional code from I70.2- through I70.7- if the angiopathy is further specified as atherosclerotic.

The clinical information and coding guidelines discussed below provide the rationale for this tip.

Diabetic Peripheral Angiopathy

Diabetic peripheral angiopathy (DPA) is a blood vessel disease caused by high blood glucose levels or uncontrolled diabetes. It is one of the most common complications of diabetes. It affects blood vessels that carry oxygen-rich blood away from the heart. These vessels supply blood to many different parts of the body. However, DPA often affects blood vessels in the legs and feet.

DPA has two main types, namely macroangiopathy and microangiopathy. The former causes blood clots to form in large blood vessels and cause a blockage. This prevents blood from reaching vital organs, such as the heart and brain. Thus, it increases the risk of heart attack and stroke. Microangiopathy, on the other hand, affects the smaller blood vessels. The condition makes them thick and weak. As a result, the flow of blood throughout the body is slowed down. This increases the risk of diabetic retinopathy (which can lead to blindness) and kidney disease.

Diabetes increases the risk of atherosclerosis. This refers to the build-up of plaque in the arteries. Plaque is made up of substances found in blood, such as calcium and cholesterol. Too much plaque in the arteries can limit the amount of blood that flows through the affected blood vessel. It can also completely obstruct or cut off blood supply to other body parts.

ICD-10-CM Coding

Diabetes and Associated Conditions, Clarification (CC 2nd Q 2016 P. 36)
The AHA Central Office has received several questions requesting clarification of the advice published in the First Quarter 2016 issue regarding diabetes and associated conditions. The published advice is based on Guideline Section I.A.15 which says: 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 casual relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular.

The following example from the Alphabetic Index for the main term “Diabetes” and the subterm “with” demonstrates this linkage:

Diabetes, diabetic (mellitus) (sugar) E11.9

  • With
    • oral complication NEC E11.638
    • osteomyelitis E11.69
    • periodontal disease E11.630
    • peripheral angiopathy E11.51
      • with gangrene E11.52

The subterm “with” in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word “with”. The physician documentation does not need to provide a link between the diagnoses of diabetes and peripheral angiopathy to accurately assign code E11.5-, Type 2 diabetes mellitus with peripheral angiopathy. This link can be assumed since the peripheral angiopathy disease is listed under the subterm “with”. 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 and due to some other underlying cause besides diabetes. 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.

Reference: Coding Clinic Second Quarter 2018 P.7