ICD Code E11.42

ICD code E11.42 is used to classify and document a diagnosis of Type 2 diabetes mellitus with diabetic polyneuropathy. This code indicates that the patient has Type 2 diabetes, a chronic condition affecting the way the body processes blood sugar (glucose), and is also experiencing diabetic polyneuropathy, which is a type of nerve damage that can occur as a complication of diabetes. This condition often results in symptoms such as pain, tingling, or numbness, typically in the hands and feet. Proper documentation using this ICD code is crucial for accurate billing and ensuring that healthcare providers can track and manage the patient's condition effectively.

1. Diagnosis of Type 2 Diabetes Mellitus: Confirm the patient has been diagnosed with Type 2 diabetes mellitus. This is typically characterized by insulin resistance and is often associated with obesity, physical inactivity, and a family history of diabetes.

2. Presence of Diabetic Polyneuropathy: Identify the presence of diabetic polyneuropathy, a common complication of diabetes. This condition involves damage to the peripheral nerves due to prolonged high blood sugar levels.

3. Symptoms of Polyneuropathy: Document symptoms indicative of polyneuropathy, which may include:

• Numbness or reduced ability to feel pain or temperature changes, particularly in the feet and hands.
• Tingling or burning sensations.
• Sharp pains or cramps.
• Increased sensitivity to touch.
• Muscle weakness or loss of reflexes, especially in the ankle.
• Loss of balance and coordination.

4. Exclusion of Other Causes: Rule out other potential causes of neuropathy that are not related to diabetes, such as vitamin deficiencies, alcohol abuse, or other medical conditions that could cause similar symptoms.

5. Clinical Evaluation and Testing: Conduct a thorough clinical evaluation, which may include nerve conduction studies or electromyography, to confirm the diagnosis of diabetic polyneuropathy.

6. Documentation: Ensure comprehensive documentation in the patient's medical record, detailing the diagnosis of Type 2 diabetes mellitus and the associated diabetic polyneuropathy, along with the observed symptoms and any diagnostic tests performed.

By following these criteria, healthcare providers can accurately use the ICD code for Type 2 diabetes mellitus with diabetic polyneuropathy, ensuring precise medical billing and effective patient management.

For the ICD code E11.42, which pertains to Type 2 diabetes mellitus with diabetic polyneuropathy, the relevant CPT codes that may be applicable for treatment and management include:

1. 99201-99215: Evaluation and Management (E/M) codes for office or other outpatient visits, depending on the complexity and time spent with the patient.

2. 95250: Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient training, and printout of recording.

3. 95251: Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation, and report.

4. G0108: Diabetes outpatient self-management training services, individual, per 30 minutes.

5. G0109: Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes.

6. 95900-95913: Nerve conduction studies, which may be used to assess the extent of diabetic polyneuropathy.

7. A9276-A9278: Codes for therapeutic continuous glucose monitors and related supplies.

These CPT codes are examples of procedures and services that may be relevant for the management and treatment of patients with the condition associated with ICD code E11.42. It is important for healthcare providers to select the appropriate CPT codes based on the specific services rendered and the clinical scenario.

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