Health Information Management

Q&A: Linking language for diabetes and gastroparesis

CDI Strategies, May 14, 2015

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Q: Should “diabetes with gastroparesis” be coded as 536.3, diabetes with a complication code? I understood that the term ‘with’ can link two diagnoses, but that it does not represent a cause-and-effect relationship. Can you please clarify this, and why a cause-and-effect relationship can be assumed in the term “diabetes with gastroparesis.”

A: I rarely teach physicians to use the term “with” as linking language because the term is very confusing. “With” can link two conditions together: for example, diabetes with gastroparesis or Alzheimer’s dementia with a behavioral disorder.

However, the term “with” cannot demonstrate cause-and-effects related to a complication, such as linking a urinary tract infection to a Foley catheter. The documentation of “UTI with Foley” does not clearly indicate a cause and an effect—it merely communicates that the patient has both a Foley and a UTI. To create a link between the two, the provider would need to state “UTI due to indwelling Foley catheter.” Other terms that could be used to show cause and effect are “related to,” “secondary to,” and “associated with.”

When I speak “linking language” to my providers, I give them three main, simple, options: “due to,” “secondary to,” and “related to.” These will work to link two conditions, and will also suffice when identifying a complication and its underlying cause. My philosophy is keep it simple when it comes to provider education.

Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, and CDI Education Specialist at HCPro in Danvers, Massachusetts, answered this question. Contact her at  For information regarding CDI Boot Camps visit

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