DM with cellulitis query choice

sadencarnacaosadencarnacao
in Clinical & Coding

I am looking for guidance on query choice verbiage and coding for linkage/cause-and-effect relationship between DM and Cellulitis based on the advice given by AHA CC 4th Q 2017 pages 100-101 Diabetes and cellulitis and OCGs Section I.A.15 "With". Our facility has a patient who was admitted with cellulitis and has DM; the choices given in the query and response was "DM with cellulitis". In hindsight, should the query option be "cellulitis due to diabetes" since cellulitis is not included under "with", or can "diabetes with cellulitis" be interpreted to mean "cellulitis due to diabetes" according to the "with" guideline?

CC 4th Q 2017 pages 100-101 states ""Diabetes with skin complication NEC," is indexed, but "diabetes with cellulitis" is not specifically indexed. The "with" guideline does not apply to "not elsewhere classified (NEC)" index entries that cover broad categories of conditions. Specific conditions must be linked by the terms "with," "due to" or "associated with". Coding professionals should not assume a causal relationship when the diabetic complication is "NEC." The ICD-10- CM classification presumes a cause-and-effect relationship with certain specific conditions when the Alphabetic Index links the conditions by the terms "with", "due to" or "associated with".

Thank you in advance for your response.

Comments

  • deanne.wilk@hcpro.comdeanne.wilk@hcpro.com

    Hello sadencarnacao,

    You make an excellent distinction. It would be best practice to directly link the cellulitis as due to the diabetes in the query choice. The coding clinic does state as you mention Specific conditions must be linked by the terms "with," "due to" or "associated with". In this instance, I do believe it would be sufficient documentation if it was listed as diabetes with cellulitis. It is the NEC of the condition that is in question not the diabetes with "NEC condition". That would lead me to believe that as long as the linking language is tied to the condition it would be sufficient.

    Again, certainly best practice is always the highest specificity!

    Hope that helps,

    Deanne Wilk

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