Let’s discuss on types of Neuropathy, Neuropathy ICD 10 Codes guidelines with examples.
Neuropathy or nerve disease is a damage or dysfunction of one or more nerves. This results in pain, tingling, muscle weakness and numbness. Neuropathy can happen due to many reasons such as injury, exposure to toxins or metabolic problems. Most common cause of neuropathy is Diabetes. There is hereditary neuropathy also which get transferred from parent to child.
Neuropathy can occur in any nerve of the body, but peripheral neuropathy is the common type seen in most of the people. As the name says peripheral neuropathy affects peripheral nerves usually extremities (hands and feet). It does not damage nerves of brain and spinal cord.
Types of Neuropathy:
- Mononeuropathy – A single peripheral nerve gets damaged.
- Polyneuropathy – Two or more nerves in different areas get affected.
- Autonomic neuropathy – Affects the nerves which control blood pressure, sweating, digestion, heart rate, bowel and bladder emptying.
Symptoms and Tests:
Symptoms can vary in both peripheral and autonomic neuropathy because the nerves affected are different. Peripheral neuropathy symptoms can be tingling, sharp throbbing pain, lack of coordination, paralysis if motor nerves are affected. Autonomic neuropathy symptoms can be heart intolerance, excess sweat or no sweat, blood pressure changes, bladder, bowel or digestive problems.
Physician does a thorough physical examination including extremity neurological exam and noting vitals. Detailed history of the patient like symptoms, lifestyle and exposure to toxins may also help to diagnose neuropathy. Blood tests, CT, MRI, electromyography, nerve biopsy and skin biopsy are the tests used to confirm neuropathy.
Neuropathy ICD 10 Codes and guidelines:
Most of the neuropathy ICD 10 codes are located in Chapter-6 of ICD-10-CM manual which is “diseases of the nervous system”, code range G00-G99
- Check whether patient has diabetes or not. If yes, neuropathy and diabetes needs to be combined and coded regardless of it is polyneuropathy, autonomic neuropathy, mononeuropathy or unspecified neuropathy.
- Peripheral neuropathy with diabetes should be coded as E11.42 (DM with polyneuropath), not e11.40 (DM with neuropathy).
- Coder needs to check signs and symptoms in the medical record, also, check the underlying cause if anything mentioned.
- Neuropathic pain should be coded as neuralgia M79.2, not neuropathy.
Below examples will help us understanding how to code Neuropathy.
Neuropathy ICD 10 Code Example 1
Diana is a 52 year old woman coming to emergency department with throbbing pain on her legs and arms from past few weeks. Diana takes over the counter medicine for pain. But that is not giving a proper relief to her. She has a history of DM, HTN and hypercholesterolemia. Her current medication list includes humulin, metoprolol and simvastatin. Vitals were normal today. Physical exam noted dry skin and colour change. An EMG was done and it showed peripheral neuropathy.
ICD-10 codes for this scenario would be:
E11.42 – DM with polyneuropathy
I10 – Hypertension
E78.00 – Hypercholesterolemia
Z79.4 – Use of insulin
Note: DM with peripheral neuropathy should be coded as E11.42, not E11.40 (DM with neuropathy)
Neuropathy ICD 10 Code Example 2
26 year old man comes to clinic for burning pain in his lower extremities. He does not have any prior medical histories. He states that he feels numbness after walking for a while. He works in a supermarket as salesman. He is not able to perform his work well due to these problems. He has a family history of heart attack (father) and breast cancer (sister). Vitals were taken and it notes BMI 27, BP 125/75 mmHg, Physical exam showed normal skin pigmentation but decreased sensation to 10-g monofilament testing. Physician documented in the final assessment as “idiopathic neuropathy”
ICD-10 codes for this scenario would be:
G60.9 – Idiopathic neuropathy.
Note: Neuropathy idiopathic indexes to G60.9 in the index of ICD-10 CM manual. Neuropathy is idiopathic when underlying cause is unknown. This has to be diagnosed by physician. A coder cannot assume it is idiopathic.