ICD-10 Diabetic Neurological Complications: May the Four Be With You

Tue, Sep 6, 2016 --

ICD-10

ICD-10 diabetic neurological complications

It wasn’t a long time ago or in a galaxy far, far away that we started using ICD-10. And in the near future, we’ll be dealing with another change for the code set.

Starting Oct. 1, 2016, choosing the fourth ICD-10 character and beyond has added importance for your Medicare claims, as explained below. I may not be Yoda or Obi-Wan, but I can tell you to use the fourth character 4 for diabetes with neurological complications. Here’s what you need to know if you don’t want your claims going over to the dark side. (And, I promise, the Star Wars references stop here.)

Refresh Your Knowledge of CMS Family Rule’s End

When ICD-10-CM 2017 goes into effect on Oct. 1, 2016, we’ll also be facing the end of Medicare’s grace period. The short version is that for the first 12 months of ICD-10 use, as long as the first three characters of the ICD-10 code are right, “Medicare fee-for-service will process and not audit valid ICD-10 codes.” That flexibility doesn’t change requirements put in place by LCDs and NCDs, but the end of that flexibility on Oct. 1 still adds some extra incentive to be sure we’re getting all characters for diabetes ICD-10 codes correct and as specific as possible.

Get the First Three Right

In ICD-10, the first three characters of a code are the category. The category that first comes to mind when you hear diabetes may be E11.- (Type 2 diabetes mellitus), but you have several categories to choose from:

  • E08.-, Diabetes mellitus due to underlying condition
  • E09.-, Drug or chemical induced diabetes mellitus
  • E10.-, Type 1 diabetes mellitus
  • E11.-, Type 2 diabetes mellitus
  • E13.-, Other specified diabetes mellitus.

Build Your Neurological Complications Code

Fourth: For all five of the categories above, adding the fourth character 4 indicates the patient has neurological complications of diabetes.

Fifth: Getting the right fourth character isn’t the end of the battle. You need to choose the applicable fifth character from this list:

  • 0, Diabetic neuropathy, unspecified
  • 1, Diabetic mononeuropathy
  • 2, Diabetic polyneuropathy
  • 3, Diabetic autonomic (poly)neuropathy
  • 4, Diabetic amyotrophy
  • 9, Other diabetic neurological complication.

Example: For a patient with type 2 diabetes with polyneuropathy, you should report E11.42 (Type 2 diabetes mellitus with diabetic polyneuropathy).

Simplify With Documentation You Can Count On

You can use the same building blocks we used above to create documentation templates so you have all of the information you need for coding neurological complications of diabetes. You also may want to include information from the Tabular showing that fifth character 2 applies to diabetic neuralgia and fifth character 3 applies to diabetic gastroparesis, so you and your providers can easily see which codes apply to those conditions.

What About You?

How do you make sure you get all the diabetes documentation you need?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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