Pain Management Coding Alert

ICD-9 had a lot of options, but ICD-10 has even more.

If your physician treats a patient diagnosed with diabetic neuropathy, be prepared to have numerous ICD-10 code choices for your claim. Also be prepared to look for documentation regarding the type of diabetes the patient has, as this can lead you to shift from one group of codes to another.

ICD-9 included numerous code choices for patients with diabetic neuropathy. Some common examples were:

• 249.6 – Secondary diabetes mellitus with neurological manifestation
• 250.60 – Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled
• 250.61 – Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled
• 250.62 – Diabetes with neurological manifestations, type II or unspecified type, uncontrolled
• 250.63 – Diabetes with neurological manifestations, type I [juvenile type], uncontrolled
• 250.6 – Diabetes with neurological manifestations
• 357.2 – Polyneuropathy in diabetes.

Now that you’re coding with ICD-10, your options are much greater. 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, but a few of the generally approved codes/code families are:

• E08.4~ – Diabetes mellitus due to underlying condition with diabetic neuropathy
• E08.42 – Diabetes mellitus due to underlying condition with diabetic polyneuropathy
• 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
• 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
• E13.4~ – Other specified diabetes mellitus with neurological complications
• E13.42 – Other specified diabetes mellitus with diabetic polyneuropathy.

The repetitive fifth character throughout 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: These codes are only examples of some covered diagnoses; this is not meant to be a complete list. Check your Medicare carrier’s local coverage determination (LCD) for specific codes.