February Coding Tip – Relational Terms:  “and”, “with”, and “in”

 

The TrustHCS education team provides regular in-service coding tips to our team of credentialed coding professionals. This month, relational terms like “and”, “with”, and “In” were discussed. As you will see, the interpretation of these words regarding their ICD-10 relations and their placement in either the code title of the Alphabetic Index, is crucial.

 

The Breakdown

 

“And” — When used in a code title the word “and’ should be interpreted as either “and” or “or”. Here is an example:

 

 

“With” and “In” – When used in a code title, the word “with” and “in” should be interpreted as to mean “associated with” or “due to”. The subterm “with” in the Alphabetic Index is sequenced immediately following the main term and presumes a casual relationship between two conditions linked by “with” and “in”.

 

  • This should always be coded as related, even in absence of provider documentation linkage, unless another guideline exists that specifically requires a documented linage between two conditions. (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with sepsis)
  • 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.

 

Here are some examples from the Alphabetic Index for the subterm “with” and “in” demonstrating the linkage between conditions (coding guidelines states documentation linkage is not required):

 

Diabetes; with:

 

Anemia; in (due to) (with):

 

Gout; in (due to) (with)

 

Dementia; in (due to)

 

A Follow-Up

 

The word “with” or “in” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions, which is linked by these terms in the Alphabetic 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 the conditions are unrelated or another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”). For conditions not specifically linked by these relational terms in the classification, or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related.

The word “with” in the Alphabetic Index is sequenced immediately following the main term, or subterm, not in alphabetical order.

 

Reference:  ICD-10-CM Official Guidelines for Coding and Reporting. Section I.  Convention, general coding guidelines and chapter specific guidelines. A Conventions for the ICD-10-CM.  15. “With”