How Do I Code Diabetes With Neuropathy? E11.40 to E11.49 and the Charcot Joint
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Editorial explanation — not an official CMS/CDC rule. Official coding instructions and source material are identified below. How to read the labels
Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources
Quick answer · MedCoder editorial
Diabetic neuropathy takes one combination code chosen by the documented type: E11.40 when the record says only “diabetic neuropathy,” E11.41 mononeuropathy, E11.42 polyneuropathy (including diabetic neuralgia), E11.43 autonomic neuropathy (including diabetic gastroparesis), E11.44 amyotrophy, E11.49 other. Neuropathic arthropathy — the Charcot joint — is a separate combination code, E11.610. The link to the diabetes is presumed through “with.”
Jump to the decision rule ↓What decides the answer?
Why it matters
Why: one subcategory, several documented types
Under Section I.C.4.a the neuropathy codes are combination codes — type 2 diabetes, nervous system, the specific neuropathy. The Index route “Diabetes › type 2 › with › neuropathy” gives E11.40, and the “with” subterm carries Section I.A.15’s presumption: the neuropathy is coded as diabetic unless the provider states it is unrelated. The tabular then splits the subcategory by type, and two inclusion terms do a lot of the work: E11.42 includes “diabetic neuralgia,” and E11.43 includes “diabetic gastroparesis” — diabetic gastroparesis is coded to E11.43, the autonomic neuropathy, not to E11.40. K31.84, Gastroparesis, carries a Code First note that names E11.43, so if K31.84 is also reported it follows the diabetes code.
How to apply it
How to apply the rule
- Confirm the diabetes and the neuropathy are both documented. “Neuropathy” in a diabetic patient with no other stated cause is coded to E11.4- (I.A.15).
- Match the documented type: unspecified → E11.40; mononeuropathy → E11.41; polyneuropathy or “peripheral neuropathy” documented as polyneuropathy, or diabetic neuralgia → E11.42; autonomic neuropathy or diabetic gastroparesis → E11.43; amyotrophy → E11.44; other neurological complication → E11.49.
- Look for the Charcot joint. Neuropathic arthropathy is E11.610 (inclusion term “Charcôt’s joints”) — a musculoskeletal combination code, reported in addition to the neuropathy code when both are documented. The arthropathy guide linked below covers why M14.6- is excluded.
- Verify in the Tabular; add the Z79 control code and any other E11 complication codes; sequence by the reason for the encounter.
Examples
Coding examples
- Type 2 diabetes; “diabetic peripheral polyneuropathy” in both feet; on insulin.E11.42 → Z79.4.
- Type 2 diabetes; gastroparesis documented as diabetic.E11.43 — the inclusion term names diabetic gastroparesis, and the Index entry “Gastroparesis, diabetic” points to it. If K31.84 is also reported, its Code First note places E11.43 first.
- Type 2 diabetes; “neuropathy,” type not stated.E11.40.
- Type 2 diabetes with polyneuropathy and a Charcot joint of the right ankle.E11.42 and E11.610 — two combination codes, one per documented complication, as I.C.4.a directs.
Common mistakes
Common mistakes
- Coding E11.9 plus a G-chapter neuropathy code because the note does not say “due to diabetes” — the “with” presumption makes E11.4- the code.
- Coding diabetic gastroparesis to E11.40 or to K31.84 alone — E11.43 names it as an inclusion term, and K31.84’s Code First note places E11.43 first.
- Coding a Charcot joint to M14.6- in a diabetic patient — M14.6 excludes it; E11.610 is the code.
- Selecting E11.42 for “neuropathy” without a documented polyneuropathy — E11.40 is the unspecified code.
Documentation matters
Documentation that changes the coding
- The neuropathy type — mono-, poly-, autonomic, amyotrophy — from the provider.
- A statement that the neuropathy has a cause other than the diabetes, which removes the E11.4- code (I.A.15).
- Gastroparesis documented as diabetic (E11.43) versus documented with another cause.
- Neuropathic arthropathy, which adds E11.610.
Decision rule
Decision framework
| IF the record says… | THEN… |
|---|---|
| Diabetic neuropathy, type not stated | E11.40 |
| Mononeuropathy / polyneuropathy or neuralgia / autonomic or gastroparesis / amyotrophy | E11.41 / E11.42 / E11.43 / E11.44 |
| Another documented neurological complication of the diabetes | E11.49 |
| Charcot joint (neuropathic arthropathy) | E11.610, in addition to the neuropathy code |
| Provider states the neuropathy is not due to the diabetes | Diabetes code without the neurological complication + the neuropathy’s own code |
FAQ
Does the provider have to link the neuropathy to the diabetes?
No. The Alphabetic Index lists neuropathy under “Diabetes › with,” and Section I.A.15 presumes the relationship unless the documentation states the conditions are unrelated. “Diabetic neuropathy” or neuropathy in a diabetic patient with no other stated cause is coded to E11.4-.
How is diabetic gastroparesis coded?
E11.43, Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy, whose inclusion term is “Type 2 diabetes mellitus with diabetic gastroparesis.” K31.84, Gastroparesis, carries a Code First note naming E11.43, so if K31.84 is also reported it is sequenced after E11.43.
Which code is used for a Charcot joint in a diabetic patient?
E11.610, Type 2 diabetes mellitus with diabetic neuropathic arthropathy — inclusion term “Charcôt’s joints.” M14.6- carries an Excludes1 for diabetic neuropathic arthropathy, so it is not used.
Is E11.42 the code for “peripheral neuropathy”?
Only when the record documents polyneuropathy (or diabetic neuralgia, its inclusion term). “Neuropathy” with no type stated is E11.40, the unspecified code.
Code set release
This guide was verified against ICD-10-CM FY2027, effective October 1, 2026.
Code relationships
| Relationship | At | Names | Note |
|---|---|---|---|
| parent-child | E11.4 | E11.40 / E11.41 / E11.42 / E11.43 / E11.44 / E11.49 | |
| includes | E11.43 | Type 2 diabetes mellitus with diabetic gastroparesis (inclusion term) | |
| includes | E11.42 | Type 2 diabetes mellitus with diabetic neuralgia (inclusion term) | |
| includes | E11.610 | Type 2 diabetes mellitus with Charcôt’s joints (inclusion term) | |
| excludes1 | M14.6 | E08.610, E09.610, E10.610, E11.610, E13.610 | |
| hcc | E11.40 | HCC 37 — Diabetes with Chronic Complications | CMS-HCC V28, payment year 2026 mapping file |
| hcc | E11.42 | HCC 37 — Diabetes with Chronic Complications | CMS-HCC V28, payment year 2026 mapping file |
| hcc | E11.610 | HCC 37 — Diabetes with Chronic Complications | CMS-HCC V28, payment year 2026 mapping file |
| ms-drg | E11.40 | Pre-MDC — MS-DRG 008 | Definitions of MS-DRGs v44, Appendix B (diagnosis / MDC / MS-DRG index) |
| ms-drg | E11.40 | non-CC as a secondary diagnosis | Definitions of MS-DRGs v44, Appendix C Part 1 |
| ccsr | E11.40 | END003 — Diabetes mellitus with complication | AHRQ CCSR v2026-1 default inpatient category |
| ms-drg | E11.42 | Pre-MDC — MS-DRG 008 | Definitions of MS-DRGs v44, Appendix B (diagnosis / MDC / MS-DRG index) |
| ms-drg | E11.42 | non-CC as a secondary diagnosis | Definitions of MS-DRGs v44, Appendix C Part 1 |
| ccsr | E11.42 | END003 — Diabetes mellitus with complication | AHRQ CCSR v2026-1 default inpatient category |
Relationships are quoted from the FY tabular notes and Official Guidelines the guide cites; none are inferred.
Relationships are quoted from the tabular notes and Official Guidelines sections the guide cites; the wording of each row is MedCoder’s.
Compare these pairs
Each pair below is one the tabular notes link; its Compare page quotes the note and says whether the two can be reported together.
Authoritative sources
Applies to FY2027 ICD-10-CM
Verified against the FY 2027 ICD-10-CM Official Guidelines (Sections I.C.4.a and I.A.15), the FY 2027 tabular entries at E11.40–E11.49 and E11.610, and the FY 2027 Alphabetic Index entry “Diabetes, type 2, with, neuropathy.”
- ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (Section I.C.4.a; I.A.15, “With”)
- FY 2027 ICD-10-CM Tabular List (E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.610)
- FY 2027 ICD-10-CM Alphabetic Index (“Diabetes, diabetic › type 2 › with › neuropathy E11.40”)
Official guidance cited
The Official Guidelines sections this guide quotes or applies, by heading. Passages set as quotations above are the sections’ own words; the surrounding text is MedCoder’s reading of them.
- Section I.C.4.a — Diabetes mellitus
- Section I.A.15 — “With”
Passages set as quotations are verbatim official text from the sources listed. Surrounding explanation, decision tables and examples are MedCoder’s editorial reading of those sources and are not official statements. Examples are illustrative; they assign no code to any real patient.
Coder Takeaway: One combination code by documented type — E11.40 unspecified, .41 mono-, .42 poly- (neuralgia), .43 autonomic (gastroparesis), .44 amyotrophy, .49 other — with E11.610 added for a Charcot joint; the link to the diabetes is presumed.
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Applicable code set: FY2027. Published September 3, 2026; last updated October 1, 2026; last reviewed October 1, 2026.