Q: Can “in the setting of”' be interpreted as “due to” in ICD-10-CM? For example, the physician documented that the patient has a urinary tract infection (UTI) in the setting of a urinary catheter.
A: Coding relies on precise language. If you look at the code book, the Tabular List and the Alphabetic Index actually use the term "due to" and CMS has provider compliance newsletters where it talks about the need to use “due to.”
The problem with the phrase “in the setting of” is it’s just saying two conditions coexist rather than saying that a cause-and-effect relationship exists. If the physician documented a UTI from a catheter or secondary to a catheter, that’s more cause and effect like “due to,” but “in the setting of” leaves too much room for interpretation and vagueness.
If the physician documented UTI with urinary catheter, you could code it as “due to” because The ICD-10-CM Official Guidelines for Coding and Reporting state that the word "with" should be interpreted to mean associated with or due to when it appears in a code title.
Editor’s Note: Cheryl Ericson, MS, RN, CCDS, CDIP, AHIMA-approved ICD-10-CM/PCS trainer, Associate Director for Education at ACDIS and CDI Education Director at HCPro, a division of BLR, in Danvers, Massachusetts, answered this question on the ACDIS website.
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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