ICD Code E11.21

ICD code E11.21 is used to classify and document a diagnosis of Type 2 diabetes mellitus with diabetic nephropathy. This code indicates that the patient has Type 2 diabetes, a chronic condition that affects the way the body processes blood sugar (glucose), and it is accompanied by diabetic nephropathy, which is a kidney disease or damage resulting from diabetes. This code is crucial for healthcare providers to accurately record and communicate the specific complications associated with a patient's diabetes, ensuring appropriate treatment and management strategies are employed.

1. Diagnosis of Type 2 Diabetes Mellitus: The patient must have a confirmed diagnosis of Type 2 diabetes mellitus. This is typically characterized by insulin resistance and relative insulin deficiency, often associated with obesity and a sedentary lifestyle.

2. Presence of Diabetic Nephropathy: The patient must exhibit signs of diabetic nephropathy, which is a kidney-related complication of diabetes. This can include persistent albuminuria (protein in the urine), a progressive decline in the glomerular filtration rate (GFR), and elevated blood pressure.

3. Laboratory Findings: Laboratory tests should confirm the presence of microalbuminuria or macroalbuminuria. A urine albumin-to-creatinine ratio (UACR) greater than 30 mg/g is indicative of nephropathy.

4. Clinical Symptoms: The patient may present with symptoms such as swelling in the hands, feet, or face due to fluid retention, fatigue, and changes in urination patterns, including increased frequency or foamy urine.

5. Exclusion of Other Causes: Other potential causes of kidney disease should be ruled out to confirm that the nephropathy is specifically related to diabetes. This may involve a thorough review of the patient's medical history and additional diagnostic testing.

6. Monitoring and Follow-Up: Regular monitoring of kidney function and diabetes management is essential. This includes periodic testing of blood glucose levels, HbA1c, and kidney function tests to assess the progression of nephropathy.

By adhering to these diagnostic criteria, healthcare providers can accurately use the ICD code for Type 2 diabetes mellitus with diabetic nephropathy, ensuring proper documentation and facilitating effective treatment planning.

For the ICD code E11.21, which is associated with type 2 diabetes mellitus with diabetic nephropathy, the relevant CPT codes that may be applicable for treatment and management include:

1. 99201-99215: Evaluation and Management (E/M) services, which cover office or other outpatient visits. The specific code within this range would depend on the complexity and time spent during the patient encounter.

2. 82947: Glucose; quantitative, blood (except reagent strip).

3. 83036: Hemoglobin; glycosylated (A1c).

4. 81001-81003: Urinalysis, which may be performed to monitor kidney function.

5. 90935-90999: Dialysis services, if the nephropathy has progressed to a stage requiring dialysis.

6. 99231-99233: Subsequent hospital care, per day, for the evaluation and management of a patient, if hospitalization is necessary.

7. G0108-G0109: Diabetes outpatient self-management training services, which may be necessary for patient education and management.

8. 90632-90636: Vaccinations, such as hepatitis B, which are often recommended for diabetic patients.

These CPT codes are examples of the types of services that may be billed in the management of a patient with type 2 diabetes mellitus with diabetic nephropathy. The specific codes used would depend on the individual patient's treatment plan and the services provided.

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