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Diabetic Peripheral Neuropathic PainA large proportion of the medical billing and coding work for primary care physicians, pain management specialists and neurologists relate to services provided for patients with diabetic neuropathy. Experts say that diabetic neuropathy occurs due to high levels of blood sugar that damage the nerves and blood vessels.

The most common form of diabetic neuropathy is peripheral neuropathy, which is typically characterized by pain and numbness in the extremities including arms, feet, legs, hands, and toes. About 10-20 percent of people with diabetes will eventually develop peripheral neuropathy. A new study from the Max Delbruck Centre for Molecular Medicine in Germany brings hope to people with diabetic peripheral neuropathic pain (DPNP). The scientists say that they have discovered a method that can reverse DPNP. Their findings were published in journal Nature Neuroscience.

The researchers identified and successfully tested a molecule that can stall the function of a protein that turns touch receptors into pain receptors under the skin. Skin has specialized receptors that can even detect extremely small movements as they are sensitive to the slightest touch. The scientists successfully conducted the test in mice which have neural and cellular make up that is similar to humans.

Seen in the hand and feet, the symptoms of DPNP include numbness, tingling and burning, cramps, and sudden, sharp pains. The aim of treatment will be to first address any contributing underlying factors such as infection, toxin exposure, medication-related toxicity, autoimmune disorders, or vitamin disorders that can lead to neuropathy. While recommending measures to manage the patient’s glucose level to help prevent additional damage to the nerves, neurologists will recommend oral medications and topical agents which act on the central nervous system to ease pain.

However, pain medications that act on the central nervous system often trigger negative side effects. According to the new study, directly targeting nerve receptors in the skin silences the pain receptors.

Diagnosis of diabetic neuropathy is fairly straightforward and will involve a physical exam and nerve tests. Medical coding outsourcing to a reliable service provider will ensure diagnostic code assignment for appropriate reimbursement. In ICD-10, diabetic neuropathies are combination codes within the 5 diabetic code categories E08, E09, E10, E11, and E13. The correct code for diabetic neuropathy depends on which type of diabetes the patient has.

In ICD-10, diabetic peripheral autonomic neuropathy requires only one code:

  • E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy

Similarly, diabetic peripheral neuropathy would also only require one code:

  • E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy

Other diabetic neuropathy codes:

  • E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy
  • E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified
  • E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified
  • E13.42 Other specified diabetes mellitus with diabetic polyneuropathy
  • G57.90 Unspecified mononeuropathy of unspecified lower limb
  • G57.91 Unspecified mononeuropathy of right lower limb
  • G57.92 Unspecified mononeuropathy of left lower limb
  • G89.29 Other chronic pain
  • R52 Pain, unspecified

Physicians should thoroughly document each patient’s specific condition for proper medical coding and billing. Patients who have diabetes also often have additional conditions such as hypertension, hyperlipidemia, and obesity, and may use tobacco products. Many patients with diabetes mellitus also suffer from depression. These additional issues require separate diagnostic codes which may have almost as many combinations as the diabetes mellitus codes have. Proper documentation will allow the medical coding service provider to accurately code patients with additional complications.