ICD-10 Coding for Diabetic Nephropathy(E11.21, E10.21)
Complete ICD-10-CM coding and documentation guide for Diabetic Nephropathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diabetic 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 nephropathy is explicitly linked to type 2 diabetes. |
|
| E10.21 | Type 1 diabetes mellitus with diabetic nephropathy | Use when nephropathy is explicitly linked to type 1 diabetes. |
|
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 diabetic nephropathy
Essential facts and insights about Diabetic Nephropathy
Primary ICD-10-CM Codes for diabetic nephropathy
Decision Criteria
clinical Criteria
- Presence of albuminuria and reduced eGFR
documentation Criteria
- Explicit mention of diabetic nephropathy
Applicable To
- Diabetic nephropathy due to type 2 diabetes
Excludes
- Type 1 diabetes mellitus with nephropathy (E10.21)
Clinical Validation Requirements
- Albuminuria ≥30 mg/g
- eGFR <60 mL/min/1.73m²
- Biopsy-proven glomerular damage
Code-Specific Risks
- Ensure nephropathy is linked to diabetes in documentation.
Coding Notes
- Ensure documentation specifies the link between diabetes and nephropathy.
E10.21 - Type 1 diabetes mellitus with diabetic nephropathy
Use when nephropathy is explicitly linked to type 1 diabetes.
Applicable To
- Diabetic nephropathy due to type 1 diabetes
Excludes
- Type 2 diabetes mellitus with nephropathy (E11.21)
Clinical Validation Requirements
- Albuminuria ≥30 mg/g
- eGFR <60 mL/min/1.73m²
- Biopsy-proven glomerular damage
Coding Notes
Ensure documentation specifies the link between diabetes and nephropathy.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic kidney disease, stage 3
N18.3Differential 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 Diabetic 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: Leads to vague clinical data., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always specify the type of diabetes and nephropathy., Ensure CKD stage is documented.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation explicitly links nephropathy to diabetes.
Impact
Failure to document the link between diabetes and nephropathy.
Mitigation Strategy
Educate providers on documentation requirements.
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 Diabetic Nephropathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diabetic Nephropathy
Use these documentation templates to ensure complete and accurate documentation for Diabetic Nephropathy. These templates include all required elements for proper coding and billing.
Nephrology Consult
Specialty: NephrologyRequired Elements
- Chief complaint
- History of present illness
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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