The word “with” or “in” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated….For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related.
Coding Diabetes with Hypertension
As I understand the guidelines, if the provider has only documented “diabetes with hypertension”, then you would not presume a causal relationship between the two because the two terms “diabetes” and “hypertension” are not linked in ICD-10 by the term “with”. If the provider has specifically documented that the hypertension was caused by the diabetes, then you would code the hypertension as a circulatory complication. Only the terms listed in the index under “diabetes with” should be coded as a complication with specific documentation linking them. See the instructional note in Section I, part A – Conventions for the ICD-10-CM: