ICD Code E11.43

ICD code E11.43 is used to classify and document a diagnosis of Type 2 diabetes mellitus when it is accompanied by diabetic autonomic (poly)neuropathy. This code is part of the ICD-10-CM system, which healthcare providers use to ensure accurate billing and efficient management of patient records. The code indicates that the patient has Type 2 diabetes and is experiencing complications affecting the autonomic nervous system, which can impact various bodily functions such as heart rate, digestion, and respiratory rate. Proper documentation with this code helps in the management of the patient's condition and facilitates appropriate reimbursement processes.

1. Diagnosis of Type 2 Diabetes Mellitus: Confirm the patient has been diagnosed with Type 2 diabetes mellitus, characterized by insulin resistance and often associated with obesity and a sedentary lifestyle.

2. Presence of Autonomic Neuropathy: Identify symptoms indicative of autonomic neuropathy, which may include gastrointestinal issues (such as gastroparesis), cardiovascular symptoms (such as orthostatic hypotension), genitourinary problems (such as bladder dysfunction), or sudomotor dysfunction (such as abnormal sweating).

3. Exclusion of Other Neuropathies: Rule out other types of neuropathies that are not related to diabetes, ensuring that the neuropathy is specifically linked to the diabetic condition.

4. Chronicity and Progression: Document the chronic nature and progression of the neuropathy symptoms, which are consistent with diabetic autonomic neuropathy.

5. Clinical Evaluation and Testing: Conduct appropriate clinical evaluations and tests to support the diagnosis, such as nerve conduction studies, autonomic function tests, or other relevant diagnostic procedures.

6. Comprehensive Patient History: Review the patient's medical history for evidence of long-standing diabetes and any previous documentation of neuropathic symptoms.

7. Symptom Correlation with Diabetes: Ensure that the neuropathic symptoms correlate with the patient's diabetic status, and are not attributable to other medical conditions or external factors.

By following these diagnostic criteria, healthcare providers can accurately determine when to use the specific ICD code for Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy.

For the ICD code E11.43, which pertains to Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy, 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. 95921-95923: Codes for autonomic nervous system function testing, which may be used to assess the extent of autonomic neuropathy.

7. 96372: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular, which may be used for administering medications related to diabetes management.

These CPT codes are examples and may vary based on the specific services provided, the healthcare provider's scope of practice, and the patient's individual treatment plan. Always ensure that coding is accurate and compliant with the latest guidelines and payer policies.

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