"In the setting of..." does this link the conditions?

tpeyton1

I have physician's who document medical conditions in the setting of  another condition - examples:  compression fracture in the setting of osteoporosis.      Can this be interpreted as a link to a osteoporotic fracture (pathologic fracture) if there is no acute trauma?

cindys@hollandhospital.org

we do not --- due to or secondary to are audit proof

laura.rogers@franciscanalliance.org

Our department's decision was "no." We query for the link. 

"In the setting of..." merely states that two conditions co-exist, not that they are linked.  Our decision is pretty conservative, I would not be surprised if other facilities allowed it as it is certainly a gray area!

Laura R.

cindys@hollandhospital.org

Per AHA “in the setting of” does not necessarily indicate a cause and effect relationship. If the documentation is not clear query for clarification.

Example: Bleeding “in the setting of” anticoagulation.  4-21-17

evanspx@sutterhealth.org

Regarding fractures and osteoporosis,  please see the Current Official Guidelines for pertinent references.

jozog@cayugamed.org

Seems like in the CDI bootcamp workbook for ICD-10 stated that this could be a direct relationship the example was UTI in setting of chronic foley if I remember correctly

cseluke

We query for a relationship when we see "in the setting of" language. 

lprescott1

Per the comment above- "Seems like in the CDI bootcamp workbook for ICD-10 stated that this could be a direct relationship the example was UTI in setting of chronic foley if I remember correctly". I would consider the wording of "in the setting of" as meaning "with". And in this example of the UTI and the foley this would not allow you to assign the complication code. for a direct cause and effect relationship to assign a complication code the word with cannot be used. We would need to apply more direct linking language such as "due to" related to" etc.  Our Bootcamp teachings stress that 'with" cannot be used in this situation per Coding Clinic, Second Quarter 2012 Page: 20 . 

In contrast "in the setting of" could be used in my opinion to link two conditions. for example "Osteomyelitis, in the setting of trauma to the extremity". i do suggest each organization work to write a list of what descriptors are considered to denote uncertainty versus certainty. I find that each organization often has different interpretations. If you develop a list the coders, CDIs and providers could be workign off the same definitions.