Neurology & Pain Management Coding Alert

Question: Our neurologist saw a diabetic patient and diagnosed him with peripheral neuropathy. What ICD-9 code should I use?

Colorado Subscriber

Answer: When a patient who previously has a diabetes mellitus (DM) diagnosis develops a neuropathy due to the diabetes, consider the former (the DM) as the primary disease and the latter (the neuropathy) as the manifestation of the former (DM). For your scenario, you should code diabetic neuropathy as:

• 250.60 -- Diabetes with neurological manifestations; type II or unspecified type, not stated as uncontrolled

• 337.1 -- Peripheral autonomic neuropathy in disorders classified elsewhere. Peripheral neuropathy represents destruction of the peripheral nerves caused by specific acquired conditions. Therefore, you should always look out for the pre-existing condition that may have caused the neuropathy. Conversely, not all cases of peripheral neuropathy may have identifiable causes and therefore they can stand as the primary diagnosis in the ICD-9 coding manual.

Apart from diabetes mellitus, other medical conditions you need to know that may cause peripheral neuropathy include hypoglycemia, amyloidosis, gout, hyperthyroidism, diphtheria, porphyria, sarcoidosis, vitamin B deficiencies, beriberi, pellagra, and uremia.

All these conditions when associated with peripheral neuropathy must be coded as the primary diagnosis with the neuropathy as the secondary code.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.