I am confused about a patient having hypertension and chronic diastolic CHF and linking those conditions without the physician documenting a causal relationship. I understand the causal relationship between diabetes and what conditions appear under the word “with” but the hypertension is not as clear.
Coding Clinic in May 2016 advised home health coders that the word “with” in ICD-10 coding manuals should be interpreted to establish a cause-and-effect relationship between a diagnosis and the subterm condition linked to it.
Heart failure can occur independent of other conditions, although it is most often associated with another diagnosis. Many of these are presumed causal relationships linked by the terms “with,” “in” or “due to” in the alphabetical index or tabular list. The most common is hypertension.
This link is presumed under the following conditions:
1. The patient has both the diagnosis and the subterm condition confirmed by the physician, and
2. There is no other cause provided for the subterm condition.
Specific documentation from the physician linking the diagnosis and the subterm condition is not required if these two requirements are met. With the patient you described it would be coded as:
I11.0, Hypertensive heart disease with heart failure
I50.32, Chronic diastolic (congestive) heart failure