ICD-9 Code Diabetic Neuropathy

ICD-9 Code Diabetic Neuropathy (International Statistical Classification of Diseases and Related Health Problems, Ninth Revision) is a numerical classification used in the diagnosis of diabetic neuropathy. The code 357.2 denotes diabetes with complications, specifically neuropathy.

Overview

Diabetic neuropathy (DN) is a common complication of diabetes mellitus and affects approximately 50% of individuals with type 2 diabetes and up to 10% with type 1 diabetes over their lifetime. 1 It can result in sensorimotor dysfunction, autonomic neuropathy, or both, causing symptoms such as pain, numbness, or weakness. Common types include peripheral neuropathy, autonomic neuropathy, and focal neuropathies.

Peripheral Neuropathy

Peripheral Neuropathy (ICD-9: 354.xx) refers to damage to the nerves outside of the brain and spinal cord. In the context of diabetes, this may manifest as numbness, tingling sensations, or pain, typically in the feet and legs. This is the most common form of DN. 2

Clinical Trials

Clinical trials are ongoing to identify effective treatments for diabetic neuropathy. For instance, research is being conducted into drugs such as sodium-glucose cotransporter-2 inhibitors (SGLT2i), which have shown promise in reducing symptoms of peripheral neuropathy in patients with type 2 diabetes. 3 Additionally, some studies are exploring non-pharmacological interventions like foot massage for alleviating neuropathic pain. 4

Idiopathic Progressive Neuropathy

Idiopathic Progressive Neuropathy (ICD-9: 356.1) is a rare but specific condition characterized by progressive degeneration of multiple peripheral nerves without an apparent cause. While it's often seen in individuals with diabetes, it can also occur in those without the disease. The treatment approach typically involves symptom management and possibly immunosuppressive medications. 5

Diabetic Autonomic Neuropathy Treatment

Diabetic Autonomic Neuropathy (DAN) involves damage to the autonomic nervous system, leading to various symptoms such as cardiovascular instability, gastrointestinal problems, urinary issues, and impaired sweating. Treatment focuses on managing symptoms through lifestyle modifications, medications, and occasionally surgical interventions when necessary. 6

Peripheral Neuropathy ICD-9 (357.xx)

Peripheral neuropathy ICD-9 (International Classification of Diseases, Ninth Revision) is a medical condition that affects the nerves outside of the brain and spinal cord. It can manifest as symptoms such as numbness, pain, tingling, muscle weakness or loss of motor function in the extremities (arms, legs, hands, feet).

Classification

ICD-9 codes for peripheral neuropathy vary based on the underlying cause or type of the condition:

• 357.0 - Peripheral neuritis (inflammation of peripheral nerves)
• 357.1 - Other peripheral neuropathies (with no specific location or etiology)
• 357.2 - Mononeuropathy (affects a single nerve)
• 357.3 - Polyneuropathy (affects multiple nerves)

Causes

Peripheral neuropathy can be caused by various factors including:

• Diabetes mellitus (Type 1 or Type 2)
• Vitamin deficiencies (B1, B6, B12, E)
• Alcoholism
• Toxins (chemotherapy drugs, heavy metals, lead poisoning)
• Infections (HIV, Lyme disease, hepatitis B and C)
• Metabolic disorders (hypothyroidism, renal failure)
• Hereditary factors
• Autoimmune diseases (rheumatoid arthritis, lupus)
• Nutritional imbalances (excessive intake of vitamin A)
• Trauma or injury (crush injuries, pressure ulcers, repetitive strain injuries)
• Exposure to cold temperatures (frostbite)
• Poor circulation due to conditions such as Raynaud's phenomenon or peripheral arterial disease
• Certain medications (antibiotics, anticonvulsants, antiretroviral agents, psychotropic drugs)
• Uremic neuropathy (nerve damage in patients with kidney failure)
• Bicycle seat neuropathy (nerve damage caused by prolonged cycling on hard or narrow seats)
• Lyrica peripheral neuropathy (off-label use of Gabapentin enacarbil for treatment of postherpetic neuralgia and diabetic neuropathy)
• Neuropathy leg (specifically affecting the lower limbs due to nerve compression or trauma)

Diagnosis and Treatment

Diagnosis of peripheral neuropathy typically involves:

1. Medical history evaluation to identify risk factors and symptoms.
2. Physical examination focusing on sensory and motor function tests, reflexes, and muscle strength.
3. Electromyography (EMG) to assess the electrical activity of muscles and nerves.
4. Nerve conduction studies to measure the speed and direction of electrical signals through affected nerves.
5. Blood tests to check for potential causes such as diabetes, vitamin deficiencies, and infections.
6. Imaging studies such as MRI or CT scans may be necessary to rule out other conditions causing similar symptoms.

Treatment depends on the underlying cause but may include:

1. Addressing the underlying condition: treating diabetes, vitamin deficiencies, infections, or stopping offending medications.
2. Pain management: over-the-counter pain relievers like acetaminophen or ibuprofen; prescription painkillers; antidepressants; topical creams and patches; nerve blocks; physical therapy; and transcutaneous electrical nerve stimulation (TENS).
3. Neuroprotective drugs: sodium channel blockers like gabapentin or pregabalin; tricyclic antidepressants; alpha-lipoic acid; amitriptyline; Venlafaxine; Duloxetine; Cymbalta; Topiramate.
4. Symptomatic treatments for specific types of peripheral neuropathy: Lyrica for diabetic neuropathy and postherpetic neuralgia; medications to improve blood flow; orthotics to correct foot deformities; surgery to release compressed nerves or treat pressure ulcers.
5. Neuropathy nutrition: maintaining a balanced diet rich in whole grains, fruits, vegetables, lean proteins, and healthy fats to support nerve health. Omega-3 fatty acids, B vitamins, and antioxidants are particularly important nutrients for nerve repair and protection. Avoid excessive intake of alcohol and vitamin A.