Physician Practice

Code-specific rules take precedence over ICD-10-CM 'with' convention, 2018 coding guidelines instruct

Physician Practice Insider, August 21, 2017

Don’t automatically presume a link between two conditions within a combination code in cases when a guideline requires that link to be explicitly documented, the latest version of ICD-10-CM coding rules clarifies.

For example, the ICD-10-CM guidelines cite the sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis.” The change clarifies that code-specific documentation requirements take precedence over the more general “with” guideline, which appears in the coding conventions section at the front of the guidelines.

As before, in cases when the two conditions are not specifically linked by a relational term such as “with,” you also should not presume a link.

The change to the ICD-10 convention for “with” is just one of dozens you’ll find in the 2018 update to the ICD-10-CM Official Coding Guidelines. The new guidelines are due to take effect Oct. 1, along with hundreds of new diagnosis code changes.

The guidelines also added an additional linking term to look for – “in.” That means when you find the words “with” or “in” in an ICD-10-CM code descriptor, the alphabetic index or an instructional note in the tabular code list, you should presume a causal relationship between the two conditions linked by those terms unless instructed otherwise.


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