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The degenerative process associated with osteoarthritis creates a painful cycle where inflamed synovial tissue produces cytokines and prostaglandins that sensitise nerve endings, while swelling and effusion mechanically restrict movement [2]

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When a diabetic patient has CKD, the coder should assign E11.22 (T2DM with CKD) and N18.x without waiting for the provider to write “CKD caused by diabetes.” The exception: if the provider explicitly states the conditions are unrelated, follow that documentation