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ICD-10 Guide
ICD-10 CodesE11.42

E11.42

Billable

Type 2 diabetes mellitus with diabetic polyneuropathy

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 E11.42 is a billable code used to indicate a diagnosis of type 2 diabetes mellitus with diabetic polyneuropathy.

Key Diagnostic Point:

E11.42 refers to Type 2 diabetes mellitus complicated by diabetic polyneuropathy, a common complication of diabetes characterized by nerve damage due to prolonged high blood sugar levels. Patients with this condition often experience symptoms such as numbness, tingling, pain, and weakness in the extremities. The pathophysiology involves metabolic and vascular changes that lead to nerve injury, primarily affecting peripheral nerves. Management of Type 2 diabetes includes monitoring blood glucose levels, maintaining HbA1c levels below 7%, and implementing lifestyle changes. Insulin therapy may be required for some patients, especially when oral medications are insufficient. Regular foot examinations and patient education on foot care are crucial to prevent further complications. Diabetic polyneuropathy can significantly impact a patient's quality of life, making early diagnosis and management essential.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate documentation of diabetes type and complications
  • Variability in symptoms and severity of polyneuropathy
  • Potential for multiple comorbidities affecting coding
  • Changes in treatment protocols and management strategies

Audit Risk Factors

  • Inadequate documentation of polyneuropathy symptoms
  • Failure to document HbA1c levels
  • Misclassification of diabetes type
  • Lack of evidence for treatment plans

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed records of blood glucose levels, HbA1c results, and treatment plans.

Common Clinical Scenarios

Management of diabetes with complications, including medication adjustments and lifestyle counseling.

Billing Considerations

Endocrinologists must document the progression of diabetic complications and their management.

Neurology

Documentation Requirements

Neurological assessments, symptom descriptions, and treatment responses.

Common Clinical Scenarios

Evaluation and management of diabetic neuropathy symptoms and related pain management.

Billing Considerations

Neurologists should document the severity and impact of neuropathy on daily functioning.

Coding Guidelines

Inclusion Criteria

Use E11.42 When
  • According to ICD
  • 10 guidelines, E11
  • 42 should be used when a patient with Type 2 diabetes has been diagnosed with diabetic polyneuropathy
  • Coders must ensure that the documentation supports the diagnosis and that the condition is actively being managed

Exclusion Criteria

Do NOT use E11.42 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for routine follow-up visits for diabetes management.

Documentation Requirements

Document patient's diabetes management plan, HbA1c levels, and any complications.

Specialty Considerations

Endocrinologists should ensure comprehensive documentation of diabetes control and complications.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetes and its complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetes and its complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetes and its complications.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of HbA1c levels in managing E11.42?

HbA1c levels are crucial in managing E11.42 as they reflect long-term glucose control. Maintaining HbA1c below 7% is associated with a reduced risk of complications, including diabetic polyneuropathy.