Neurosurgery Coding Alert

Focus on type of diabetes and neurological complications.

A common diagnosis you may come across is diabetic neuropathy. ICD-10 offers a battery of codes for this condition. This implies you need to be very specific to get the right diagnosis code. Two key steps in coding diabetic neuropathy are:

• Define the type of diabetes.
• Look for associated complications, if any.

Look For Complications

Neurologic complications are identified by the fourth character of “4.” Various Medicare administrators have their own lists of approved primary diagnostic codes for diabetic patients.

Distinguish type I and type II diabetes: As a first step, check in the clinical note for the type of diabetes.

Identify the neurological complications: Next, confirm if the diagnosis is for polyneuropathy of other neurological complications.

Accordingly, choose from the following code options:

• E10.4- -- Type 1 diabetes mellitus with neurological complications
• E10.42 – Type 1 diabetes mellitus with diabetic polyneuropathy
• E11.4- -- Type 2 diabetes mellitus with neurological complications
• E11.42 – Type 2 diabetes mellitus with diabetic polyneuropathy.

In rare cases, your physician may document diabetes to be associated with certain diseases of the pancreas or infections. In that case, you can choose from the following options:

• E08.4- – Diabetes mellitus due to underlying condition with neurological complications
• E08.42 – Diabetes mellitus due to underlying condition with diabetic polyneuropathy.

Again: Carefully, describe what the neurological complication was.

Similarly for drug induced and other specific types of diabetes, you can look at the following;

• E09.4- -- Drug or chemical induced diabetes mellitus with neurological complications
• E09.42 – Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy
• E13.4- -- Other specified diabetes mellitus with neurological complications
• E13.42 – Other specified diabetes mellitus with diabetic polyneuropathy.

Find the Cue for Fifth Character in Neurological Complications

The fifth characters in the subcategory for diabetic neurological complications are as follows:

• 40 – Diabetic neuropathy, unspecified
• 41 – Diabetic mononeuropathy
• 42 – Diabetic polyneuropathy
• 43 – Diabetic autonomic (poly)neuropathy
• 44 – Diabetic amyotrophy
• 49 – Other diabetic neurological complication.

Note: This list is not complete yet it can be a useful catalogue for diabetic neuropathy codes.  Check your Medicare carrier’s local coverage determination (LCD) for specific codes. “Keep in mind that through September, CMS has only considered the accuracy of reporting the family (the first three characters).  Subsequently, we will be responsible for the accuracy of the specific diagnosis within the family to the highest character available,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.