ICD-10 Coding for Diabetes with Nephropathy(E11.21, E11.22)
Complete ICD-10-CM coding and documentation guide for Diabetes with Nephropathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diabetes with Nephropathy
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E11.21 | Type 2 diabetes mellitus with diabetic nephropathy | Use when there is documented diabetic nephropathy with proteinuria. |
|
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease | Use when CKD is present with diabetes, regardless of proteinuria. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for diabetes with nephropathy
Essential facts and insights about Diabetes with Nephropathy
Primary ICD-10-CM Codes for diabetes with nephropathy
Decision Criteria
clinical Criteria
- Presence of proteinuria and diabetic etiology
Applicable To
- Diabetic nephropathy
Excludes
- Non-diabetic kidney disease
Clinical Validation Requirements
- Proteinuria ≥300 mg/day
- Albumin-to-creatinine ratio ≥300 mg/g
Code-Specific Risks
- Incorrectly coding as E11.9 when nephropathy is present.
Coding Notes
- Ensure documentation specifies 'diabetic nephropathy' to use E11.21.
E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease
Use when CKD is present with diabetes, regardless of proteinuria.
Applicable To
- Diabetic CKD
Excludes
- Non-diabetic CKD
Clinical Validation Requirements
- eGFR <60 mL/min/1.73m²
- Diabetic etiology
Coding Notes
Document the CKD stage to ensure accurate coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic kidney disease stages 1-5
N18.1-N18.6Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Diabetes with Nephropathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.21.
Impact
Clinical: Misrepresentation of patient's condition., Regulatory: Potential audit issues., Financial: Reduced reimbursement.
Mitigation Strategy
Use specific language linking diabetes to nephropathy.
Impact
Reimbursement: Lower reimbursement due to unspecified complications., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation specifies 'diabetic nephropathy' to use E11.21.
Impact
Risk of coding errors without specifying CKD stage.
Mitigation Strategy
Ensure CKD stage is documented and coded.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Diabetes with Nephropathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diabetes with Nephropathy
Use these documentation templates to ensure complete and accurate documentation for Diabetes with Nephropathy. These templates include all required elements for proper coding and billing.
Inpatient with diabetic nephropathy
Specialty: NephrologyRequired Elements
- Diabetes type
- Presence of nephropathy
- Proteinuria levels
- CKD stage
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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