By: Caliay Pratt, CPC, CDEO, CRC, CRHC
What are combination codes?
Combination codes can be utilized to represent a disease etiology along with its manifestations or a diagnosis and the symptoms with one single code.
How are combination codes identified?
Combination codes can be identified by the word “with” or “in” and should be interpreted to mean that the conditions are “associated with” or “due to.”
Coding guidelines associated with combination codes:
Per the ICD-10 coding guidelines, the word “with” in the code title should be interpreted to mean “associated with” or “due to.” This classification presumes a causal relationship between the two conditions even in the absence of provider documentation explicitly linking them. However, if the documentation clearly states that the two conditions are not related, then the combination code should not be selected.
| Diabetes Mellitus (DM) | Type 1 | Type 2 |
| Diabetes mellitus without complications | E10.9 | E11.9 |
| Diabetes with hyperglycemia | E10.65 | E11.65 |
| Diabetes with diabetic chronic kidney disease *Add code for CKD Stage (N18.1-N18.9) and Z99.2 if on dialysis | E10.22 | E11.22 |
| Diabetes with diabetic nephropathy | E10.21 | E11.21 |
| Diabetes with peripheral angiopathy without gangrene | E10.51 | E11.51 |
| Diabetes with peripheral angiopathy with gangrene | E10.52 | E11.52 |
| Diabetes with Polyneuropathy | E10.42 | E11.42 |
| Diabetes with foot ulcer *Use additional code to identify site of ulcer (L97.4-L97.429, L97.5-L97.529) | E10.621 | E11.621 |
| Diabetes with other skin ulcer *Use additional code to identify site of ulcer (L97.1-L97.9, L98.41-L98.49) | E10.622 | E11.622 |
| Diabetes with oral complications | E10.638 | E11.638 |
| Diabetes with hypoglycemia without coma | E10.649 | E11.649 |
| Diabetes with unspecified diabetic retinopathy *6th digit required to show with or without macular edema | E10.31- | E11.31- |
| Diabetes with other specified complication *Use additional code to identify complication | E10.69 | E11.69 |
| Circulatory Conditions | Code |
| Hypertensive heart disease with heart failure *Use additional code to identify type of heart failure | I11.0 I50.- |
| Hypertensive heart disease without heart failure | I11.9 |
| Hypertensive chronic kidney disease with stage 5 CKD or ESRD *Use additional code to identify stage of CKD | I12.0 N18.5-N18.6 |
| Hypertensive heart disease with stage 1-4 CKD, or unspecified CKD *Use additional code to identify stage of CKD | I12.9 N18.1-N18.4, N18.9 |
| Hypertensive heart and CKD with heart failure and stage 1-4 CKD *Use additional code to identify type of heart failure and stage of CKD | I13.0 N18.1-N18.4, N18.9 & I50.0- |
| Hypertensive heart and CKD without heart failure with stage 1-4 CKD *Use additional code to identify stage of CKD | I13.10 N18.1-N18.4, N18.9 |
| Hypertensive heart and CKD with heart failure & stage 5 CKD or ESRD *Use additional code to identify type of heart failure & stage of CKD | I13.11 I50.0-, N18.5, N18.6 |
| Mental, Behavioral and Neurodevelopmental Disorders | Code |
| Alzheimer’s Disease, unspecified *A code from subcategory F02.8 should always be assigned with a code from this category, even in the absence of documented dementia. | G30.9 F02.8- |
