2025 ICD-10-CM code E11.21
(Active) Effective Date: N/A Endocrine, Nutritional and Metabolic Diseases - Diabetes mellitus 4 Feed
Type 2 diabetes mellitus with diabetic nephropathy.
Medical necessity for the diagnosis of E11.21 is established by the presence of both type 2 diabetes mellitus and clinical findings of diabetic nephropathy, such as abnormal urine protein, elevated serum creatinine, and/or decreased GFR.The medical necessity for treatment and management is based on the severity of the nephropathy and its impact on the patient's overall health.
Diagnosis and management of type 2 diabetes mellitus with diabetic nephropathy involves regular monitoring of blood glucose levels, blood pressure, and kidney function. Treatment aims to control blood sugar, blood pressure, and cholesterol levels to slow the progression of kidney damage.Management often includes lifestyle modifications, such as diet and exercise, and medications, including oral antidiabetic drugs, insulin, and medications to control blood pressure and cholesterol.
In simple words: This code indicates that a patient has type 2 diabetes, which is a condition where the body doesn't use insulin properly, leading to high blood sugar.The diabetes has also caused damage to their kidneys, specifically a condition called diabetic nephropathy.
Type 2 diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia (high blood sugar) resulting from defects in insulin secretion, insulin action, or both. Diabetic nephropathy is a specific kidney disease caused by diabetes, resulting in damage to the small blood vessels in the kidneys, called glomeruli.This damage impairs kidney function and can lead to kidney failure.
Example 1: A 55-year-old patient with a history of type 2 diabetes presents with elevated creatinine and proteinuria, indicating decreased kidney function.After further testing, they are diagnosed with diabetic nephropathy., A 60-year-old patient with long-standing, poorly controlled type 2 diabetes develops swelling in the legs and fatigue.Tests reveal significantly reduced kidney function and a diagnosis of diabetic nephropathy., A patient with type 2 diabetes and established diabetic nephropathy is receiving regular dialysis due to end-stage renal disease.
Documentation should include the type of diabetes, presence of nephropathy, evidence of kidney damage (e.g., proteinuria, elevated creatinine, decreased glomerular filtration rate (GFR)), and any other related complications.The stage of chronic kidney disease should also be documented.
- Payment Status: Active
- Specialties:Endocrinology, Nephrology, Internal Medicine, Family Medicine
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Other Place of Service