E11.69/E10.69 linkage to diabetic HTN/HLD

This question arose from our Intelligent Medical Objects/IMO menu in our eHR. I wonder if there are other Physician Advisors who have an IMO menu and will share whether this code linkage is used/approved at your institution.

The menu offers this language: 'Diabetes associated with HTN' and 'DM associated with Hyperlipidemia',  and links to the codes E11.69/E10.69,  depending on whether DM is Type 1 or 2. 

This elevates the coding to a NEC complication, on par with diabetic nephropathy, neuropathy, retinopathy, etc.   In turn, reimbursement for this HCC will increase substantially.  We are a large, integrated system. Since HTN and HLD are such commonly associated dxes in DM, this may result in submission of a substantial number of these codes. We are discussing internally with Endo, and wonder if other systems using IMO have discussed this as well. 

The coding is of course up to the discretion of the Provider, but our Providers do not know the code set intimately. They really depend on the menu language to guide them in the outpatient clinic. In this case, the language is completely reasonable, but the code linkage is a higher weighted HCC they do not realize they are picking. 

At your institution, do Primary care providers and Endocrinology routinely elevate HTN and HLD to the level of commonly accepted diabetic Complications AND code them at the E11.69 level?   Certainly diabetic dyslipidemia in insulin resistance is common. The treatment targets are intensified, but treatment targets are intensified in other conditions, such as HTN in CAD for some pts, yet we do not get reimbursed at a higher level for treating it. 
 
This connection to a higher weighted HCC basically arose because of the menu language linking the two. We have submitted the mapping question twice to IMO, but they have not responded.  

Thanks,
JGAguirre 
 

Comments

  • Good question.   Correct, Diabetes with  chronic complications (HCC 18 )(v. 22) carries a higher raw risk coefficient than Diabetes without complications (HCC19) (v.22).   However, the optimal word is "complication."  HTN and HLD are not complications of Diabetes clinically.   Complications of Diabetes include retinopathy, neuropathy, nephropathy, and peripheral circulatory complications.  Although many patients have both HLD and HTN with DM, there is not the causal relationship, but rather common condition associations.  IMO is driving the provider to code E11.69 / E10.69 based on the terms "associated with."  The coding convention of "with" suggests "associated with" or "due to."  However, if you follow the alphabetical index:  Diabetes.... (subterm) with....(subterm) complication....(subterm) specified NEC (E11.69).  Furthermore, the tabular index states the code description as "Type 2 diabetes mellitus with other specified complication."  Bottom line:  IMO is not correct in the clinical association of HTN and HLD as complications of Diabetes; therefore, the codes E11.69 / E10.69 should not be assigned to represent these conditions.  
    I hope this helps!

    James Fee, MD, CCS, CCDS
  • I agree with James. I would bring this up with IMO. You caught an interesting mapping issue that they need to address. 
  • edited August 2016
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  • Thanks, Dr Antonios. We have submitted to IMO twice with no response. It is very difficult to find someone at IMO who wants to help customers in our experience. Dr Fee nicely re-states and confirms the problem we are seeing. 
    -- I appreciate y'all weighing in with your medical opinion that you do not (at least yet) routinely consider HTN and HLD to be clinical Diabetic complications.  At the basic science level, you could make a case for diabetic HLD. Our Endo dept is leaning toward it, which is one reason I am reaching out for consensus from other institutions.  Thanks much for taking time to answer!
    Jane Gammon Aguirre, MD 
    Physician Documentation and Coding

  • There is and was much debate around the mapping of DM and HTN, HLD.  Diabetic hyperlipidemia is in the medical literature and at Kaiser (where I was for 20 years, 10 in CDI/Coding), we recognized that as a legit complication in diabetes as noted in the medical literature.  With diabetics being placed on statins, it is a term that will fade as it is difficult to discern clinically.   One could make the case that diabetes contributes to HTN: cholesterol, plaque build up, stiffer walls, increased resistance, hypertension.

    That said, I do not teach my docs to try and link HTN and DM as it "feels" like upcoding although I could defend it clinically and from a coding perspective (being an MD and CPC).

    Jim Taylor, MD, CPC
    Iora Health
    Medical Director of Medicare Risk Operations
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