Find information on Type 2 Diabetes Mellitus with Peripheral Neuropathy diagnosis, including clinical documentation, ICD-10 codes E11.4 and G63.2, medical coding guidelines, healthcare provider resources, neuropathic pain management, diabetes complications, and peripheral neuropathy symptoms. Learn about diagnosis criteria, treatment options, and best practices for accurate medical record keeping related to diabetic neuropathy.
Also known as
Type 2 DM with peripheral neuropathy
Type 2 diabetes with neuropathy of the peripheral nerves.
Polyneuropathies and other disorders
Covers various peripheral nerve disorders, including those caused by diabetes.
Diabetes mellitus
Encompasses all types of diabetes mellitus, including type 2.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the diabetes Type 2?
Yes
Peripheral neuropathy present?
No
Do not code as Type 2 diabetes with neuropathy. Review patient record for correct diabetes type and code accordingly.
When to use each related code
| Description |
|---|
| Type 2 diabetes with neuropathy |
| Diabetic polyneuropathy |
| Diabetic foot ulcer |
Coding lacks laterality or site specificity (e.g., right foot, bilateral hands) impacting reimbursement and quality metrics.
Insufficient clinical documentation to support peripheral neuropathy diagnosis, leading to potential denials or audits.
Incorrect coding of other conditions related to DM2 and neuropathy (e.g., diabetic foot ulcer) causing inflated risk scores.
Q: What are the most effective evidence-based strategies for managing painful diabetic peripheral neuropathy in patients with type 2 diabetes mellitus?
A: Managing painful diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus requires a multimodal approach. First-line pharmacologic treatments supported by strong evidence include pregabalin, duloxetine, and gabapentin. Topical agents such as capsaicin or lidocaine patches can offer localized pain relief. Non-pharmacologic strategies, such as controlled exercise, patient education on foot care, and optimizing glycemic control are crucial for long-term management and prevention of progression. Explore how combination therapy and individualized treatment plans can further improve patient outcomes. Consider implementing validated patient-reported outcome measures, like the Douleur Neuropathique 4 (DN4) questionnaire, to assess treatment efficacy and tailor management strategies to individual patient needs. Learn more about the latest clinical guidelines for DPN management.
Q: How can clinicians differentiate between small fiber neuropathy and large fiber neuropathy in patients with type 2 diabetes, and what are the implications for treatment decisions?
A: Differentiating between small and large fiber neuropathy in type 2 diabetes relies on a combination of clinical presentation, patient history, and nerve conduction studies. Small fiber neuropathy primarily presents with positive symptoms like burning, tingling, and pain, often impacting temperature and pain sensation. Large fiber neuropathy manifests as numbness, loss of proprioception, and diminished reflexes, affecting vibration and position sense. Nerve conduction studies are valuable for confirming large fiber neuropathy, but they may be normal in isolated small fiber neuropathy. Distinguishing between these subtypes is critical for tailoring treatment. While some medications, like duloxetine and pregabalin, may benefit both types, other treatments may be more subtype-specific. For example, topical capsaicin may be more effective for small fiber neuropathy. Consider incorporating skin biopsies, which can demonstrate reduced intraepidermal nerve fiber density, for diagnosing small fiber neuropathy. Explore how advanced diagnostic tools and a comprehensive neurological assessment can enhance the accuracy of DPN subtyping and inform targeted treatment strategies.
Patient presents with complaints consistent with type 2 diabetes mellitus and peripheral neuropathy. Symptoms include hyperglycemia, polyuria, polydipsia, and distal paresthesias described as burning, tingling, and numbness in the bilateral lower extremities. The patient reports a family history of diabetes. Physical examination reveals diminished sensation to light touch and pinprick in a stocking-glove distribution. Vibratory sensation is also reduced in the lower extremities. Ankle reflexes are hypoactive. Laboratory results show an elevated HbA1c of 8.5%, confirming the diagnosis of diabetes. Fasting blood glucose is 160 mgdL. A lipid panel reveals elevated triglycerides and LDL cholesterol. Based on the patient's presentation, history, and laboratory findings, the diagnoses of type 2 diabetes mellitus with peripheral neuropathy are established. The patient's current medications include metformin 500 mg twice daily. The treatment plan includes optimizing glycemic control through medication adjustment, patient education on diabetes management, dietary modifications, and regular exercise. Neuropathy management will focus on symptom control with gabapentin 300 mg at bedtime, titrating as needed for pain relief. The patient was counseled on the importance of regular foot care and monitoring for diabetic complications such as foot ulcers and retinopathy. Follow-up appointment scheduled in four weeks to monitor glycemic control, assess neuropathy symptoms, and review progress with lifestyle modifications. Differential diagnoses considered included diabetic foot syndrome, vitamin B12 deficiency, and lumbar radiculopathy. ICD-10 codes E11.40, G62.9, and CPT codes 99214 and 36415 are relevant for billing and coding purposes.