E/M Hot Topic: Social Determinants of Health

E/M Hot Topic: Social Determinants of Health

April 2021

With the use of the 2021 E/M Guidelines, questions continue to surface. In this month’s E/M Hot Topic, Director of Education, Jeanie Heck, BBA, CCS, CPC, CRC discusses Social Determinants of Health. She also provides an update to Prescription Drug Management and the Ordering/Review of Tests.


For additional information about E/M Guideline Updates education, contact us.

Follow us on LinkedIn to find out when the next E/M Hot Topic is released.


E/M Hot Topic: Prescription Drug Management

February 2021

Now that we have been applying the new 2021 E/M guidelines for over a month, there’s no doubt that we have questions about some of the changes — especially the elements in MDM! Starting Feb 9th, Jeanie Heck, our Director of Education, will begin addressing “E/M Hot Topics” in monthly 10-20 minute presentations. 

For additional information about E/M Updates education, contact us.


Today’s Tip: ICD-10 Anemia in CKD

Coding Tip

When anemia NOS is present as a current condition, and the patient has underlying chronic kidney disease (CKD) or end-stage renal disease (ESRD), it is a fast track to the usage of D63.1, Anemia in chronic kidney disease (manifestation). This is assigned unless the anemia is specified as a different form and/or attributed to another condition. Much like the diabetes category, ICD-10-CM “In/With” convention assumes “due to.”


ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 Section I. A. 15.


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 (either under a main term or subterm), 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 or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).

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. The word “with” in the Alphabetic Index is sequenced immediately following the main term or subterm, not in alphabetical order.

Clinical Insight

Anemia refers to the reduction of the total number of circulating red blood cells. It is diagnosed when there is the detection of decreased hemoglobin concentration, hematocrit, or red blood cell count. Anemia in chronic kidney disease specifically falls under the category of decreased red blood cell production. 

In CKD or ESRD, kidney function is compromised to the point that blood cannot be filtered of wastes and fluid. The kidneys also produce less erythropoietin (EPO), a hormone that signals the bone marrow to produce additional red blood cells. Furthermore, in CKD patients the red blood cells are not able to survive as long in the bloodstream and suffer a premature death. Due to associated nutrient deficiencies in underlying CKD, red blood cells are not reproduced as frequently or with the same cellular integrity as in a healthy patient.

Education Disclaimer: This coding tip is intended to serve the general community and may not account for all differences in coding routines, duties, or individual client policies. The information and opinions presented here are based on the experience, training, and interpretation of the author. Although the information has been researched and reviewed for accuracy, the instructor does not accept any responsibility or liability with regard to errors, omissions, misuse, or misinterpretation. This information is intended as a guide; it should not be considered a legal or consulting opinion or advice.



Intelligence Center Innovates Coding, CDI, and EHR Education, Try It FREE!

Intellis is pleased to announce the launch of the Intellis Intelligence Center, our innovative HIM online learning platform. We invite you to take a tour of the Intelligence Center and register to join our community of passionate educators and learners.  As in introduction to online learning, we’re offering two 20-minute Coding Clinic Review courses FREE of charge. In 2018, the Intelligence Center will add dynamic training and support on a variety of topics for revenue cycle, clinical documentation improvement, and EHR professionals.  We’re committed to education and leading the way in Health Information Management.

Sharing Our Expertise: Kim Felix

At Intellis, we’re committed to “minding the business of healthcare,” and our experts are regularly called upon to provide their insights. Recently, our VP of Education and Training, Kim Felix, RHIA, CCS, authored an article for the Healthcare Financial Management Association’s (HFMARevenue Cycle Strategist. The article was a Q&A piece titled “Understanding the Many Coding Changes Related to the FY18 IPPS.” The article is available to subscribers of HFMA.

Additionally, Kim has been a frequent speaker and trainer at industry events. She will be presenting an HCC Overview at the Florida Health Information Management Association (FHIMA) Coding & Clinical Documentation Institute in Orlando, Florida on February 24, 2018. In 2017, Kim spoke at a variety of events including:

PHIMA Annual Meeting
May 2017
Lancaster, PA
Overview of HCC Coding
SePHIMA Education Session
Education Committee Co-Chair
September 2017
Philadelphia, PA
FY2018 ICD-10 Coding Updates
LVHIMA Education Session
September 2017
Bethlehem, PA
FY2018 ICD-10 Coding Updates
NEPHIMA Education Session
November 2017
Wilkes Barre, PA
FY2018 ICD-10 Coding Updates

Additional articles by our HIM industry experts are available in our eNewsletter. Complete the form below to subscribe and receive information and updates or contact us for speaking engagement information.