Pain Management Coding Alert

Hint: Key on type of diabetes, complications.

Pain management practices will often see patients who need treatment for diabetic neuropathy - nerve disorders that patients with diabetes might be suffering from. You have to be ready with steady ICD-10 knowledge when these patients appear.

Explanation: There are quite a few ICD-10 codes for this condition, and 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.

Mark Complications in Fourth Character Slot

If there are neurologic complications accompanying the diabetic neuropathy, you'll mark a "4" in the fourth character slot.

Distinguish type 1 or type 2 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 or 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 the diabetes to be associated with a patient's malignancy, Cushing's syndrome, or certain diseases of the pancreas, such as pancreatitis. 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 or chemical induced diabetes and other specific types of diabetes, such as postpancreatectomy 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.

Use These Neurological Complications Characters

The fifth characters in the E--.4- subcategory for diabetic neurological complications are:

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

Keep in mind that through September, for auditing, 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.