Hello!The provider clearly stated the CKD was due to the hypertension, not the diabetes.For another example, look at the main term "anemia" and the subterms "with", "due to" and "in". According to The Guideline these terms are all equivalent and at the same level of indentation. What if a patient is admitted with a GI Bleed and also has so form of cancer currently treated with chemotherapy, chronic kidney disease and some sort of vitamin or mineral deficiency. The provider specifically documents the patient has anemia due to acute blood loss but does not "clearly state" the anemia is not due to the other associated conditions. How many anemia codes are you going to assign? One for the acute blood loss anemia or a total of five for the other conditions the physician did not explicitly state were not related? Are you going to query the physician every time this situation occurs?I believe when a physician specifically documents what the underlying cause of a condition is, the other possible "with" conditions are implied to be not associated. Also, keep in mind that it is not just the Index, but also the Tabular List that the "with" Guideline applies. It is right there in the guideline. What if the same patient comes in with a GI bleed and undergoes both a colonoscopy and an EGD. During the colonoscopy the patient is found to have diverticulosis and during the EGD is found to have gastritis, a gastric ulcer, and duodenal AVMs. The physician specifically documents the GI Bleed is due to the gastric ulcer but does not "clearly state" the GI Bleed is not related to the other documented conditions. How many GI diagnoses "with hemorrhage" are you going to assign, one or four? I believe the physician has clearly documented the cause of the GI Bleed and the other conditions should be documented as "without".If you believe that all conditions that involve the "with", "due to", or "in" association must have all possible associated conditions clearly documented as being unrelated even in circumstances where the provider clearly documents the condition is associated with only one condition then you better consistently assign all possible associations or query the provide to be sure only one diagnosis was associated with the condition.