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E09.43 ICD-10-CM Code: Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 8 Excludes1 · 6 use-additional codes · 1 code-first instruction
Risk adjustment
CMS-HCC V22 category 18 · RxHCC V08 category 30

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 008 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT (MDC PRE)
  • MS-DRG 010 — PANCREAS TRANSPLANT (MDC PRE)
  • MS-DRG 019 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS (MDC PRE)
  • MS-DRG 073 — CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC (MDC 01)
  • MS-DRG 074 — CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC (MDC 01)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for E09.43 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on E09.43 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Drug or chemical induced diabetes mellitus with diabetic gastroparesis

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from E09

Code First

Underlying conditions that must be sequenced before this code.

  • poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)

Source: inherited from E09

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
  • Use additional code to identify control using:
  • injectable non-insulin antidiabetic drugs (Z79.85)
  • insulin (Z79.4)
  • oral antidiabetic drugs (Z79.84)
  • oral hypoglycemic drugs (Z79.84)

Source: inherited from E09

Coder workflow for E09.43

MedCoder structured workflow — derived from this code’s own official record

Before you code E09.43

  1. E09.43’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  2. Confirm the documented diabetes type or cause (the E08–E13 categories are separated by it) and every documented complication or manifestation; the code is built from the type first and the complication second. Then work the category’s Use Additional Code notes for medication and control status. Type 2 is the default only when the type is not documented, and insulin or other medication use does not by itself establish the type (Guidelines I.C.4.a.2, I.C.4.a.3).

    Guide: Secondary diabetes (E08, E09, E13) →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with E09.43. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in E09.43’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewE08, O24.4, P70.2, E13, E10, E11

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then E09.43.
    No → Continue; do not add an underlying condition the record does not document.

Consider E09.43. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.
Diabetes type or cause, each complication, and medication use
The type is documented, not inferred from medication (Guidelines I.C.4.a.3); each documented complication takes its own combination code.

Official instructions as workflow

  • Excludes1 — check before selecting E09.43(8 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with E09.43: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareE08, O24.4, P70.2, E13, E10, E11

    See the official tabular notes · Guidelines I.A.12.a

  • Code First — sequencing check(1 note)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before E09.43. Do not add an underlying condition the record does not document.

    See the official tabular notes · Guidelines I.A.13

  • Use Additional Code — after identifying E09.43(6 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with E09.43 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewZ79.85, Z79.4, Z79.84

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition E09.43 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewE08, O24.4, P70.2, E13, E10, E11

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is E09.43 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy is a billable ICD-10-CM diagnosis code (E09.43).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00 -E89)

6) Secondary diabetes mellitus Codes under categories E08, Diabetes mellitus due to underlying condition, E09, Drug or chemical induced diabetes mellitus, and E13, Other specified diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes is always caused by another condition or event (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning).

Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00 -E89)

(b) Assigning and sequencing secondary diabetes codes and its causes The sequencing of the secondary diabetes codes in relationship to codes for the cause of the diabetes is based on the Tabular List instructions for categories E08, E09 and E13.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. Sequencing: 1 Code First instruction — the underlying condition is sequenced before this code when present. See the Code First notes
  2. 6 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  3. 8 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name E09.43 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 23 Excludes1 notes across 8 chapters: E08 — Diabetes mellitus due to underlying condition (via E09.-), E10 — Type 1 diabetes mellitus (via E09.-), E11 — Type 2 diabetes mellitus (via E09.-), E13 — Other specified diabetes mellitus (via E09.-), E74 — Other disorders of carbohydrate metabolism (via E09.-), E87.2 — Acidosis (via E09.-), G54.5 — Neuralgic amyotrophy (via E09.-), G59 — Mononeuropathy in diseases classified elsewhere (via E09.-), G63 — Polyneuropathy in diseases classified elsewhere (via E09.-), G99.0 — Autonomic neuropathy in diseases classified elsewhere (via E09.-), H20.0 — Acute and subacute iridocyclitis (via E09.-), I73.8 — Other specified peripheral vascular diseases (via E09.-), I79.8 — Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere (via E09.-), L92.1 — Necrobiosis lipoidica, not elsewhere classified (via E09.-), L99 — Other disorders of skin and subcutaneous tissue in diseases classified elsewhere (via E09.-), M14 — Arthropathies in other diseases classified elsewhere (via E09.-), M14.6 — Charcôt's joint (via E09.-), M90 — Osteopathies in diseases classified elsewhere (via E09.-), N08 — Glomerular disorders in diseases classified elsewhere (via E09.-), N16 — Renal tubulo-interstitial disorders in diseases classified elsewhere (via E09.-), +3 more.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 3 Excludes2 notes across 3 chapters: H35 — Other retinal disorders (via E09.-), I96 — Gangrene, not elsewhere classified (via E09.-), K31 — Other diseases of stomach and duodenum.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 2 Code First instructions across 2 chapters: D84.81 — Immunodeficiency due to conditions classified elsewhere (via E09.-), K31.84 — Gastroparesis.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Referenced by 1 Code Also instruction: N76.82 — Fournier disease of vagina and vulva (via E09.-).

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 5 MS-DRGs: DRG 008 (MDC PRE), DRG 010 (MDC PRE), DRG 019 (MDC PRE), DRG 073 (MDC 01), DRG 074 (MDC 01).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):END003 — Diabetes mellitus with complication (default); END006 — Diabetes mellitus, due to underlying condition, drug or chemical induced, or other specified type; NVS015 — Polyneuropathies.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Diabetes mellitus with complication, Diabetes mellitus, due to underlying condition, drug or chemical induced, or other specified type, Polyneuropathies).

E09.3599 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye, E09.36 — Drug or chemical induced diabetes mellitus with diabetic cataract, E09.37X1 — Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye, E09.37X2 — Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye, E09.37X3 — Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral, E09.37X9 — Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye, E09.39 — Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication, E09.40 — Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified, E09.41 — Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy, E09.42 — Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy, E09.44 — Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy, E09.49 — Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication, E09.51 — Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene, E09.52 — Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene, E09.59 — Drug or chemical induced diabetes mellitus with other circulatory complications, E09.610 — Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy, E09.618 — Drug or chemical induced diabetes mellitus with other diabetic arthropathy, E09.620 — Drug or chemical induced diabetes mellitus with diabetic dermatitis, E09.621 — Drug or chemical induced diabetes mellitus with foot ulcer, E09.622 — Drug or chemical induced diabetes mellitus with other skin ulcer, +498 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Diabetes, diabetic”; these codes share that main term but sit in a different category of the Tabular List.

E08.622 — Diabetes mellitus due to underlying condition with other skin ulcer (due to underlying condition, with, skin ulcer NEC), E08.628 — Diabetes mellitus due to underlying condition with other skin complications (due to underlying condition, with, skin complication NEC), E08.630 — Diabetes mellitus due to underlying condition with periodontal disease (due to underlying condition, with, periodontal disease), E08.638 — Diabetes mellitus due to underlying condition with other oral complications (due to underlying condition, with, oral complication NEC), E08.641 — Diabetes mellitus due to underlying condition with hypoglycemia with coma (due to underlying condition, with, hypoglycemia, with coma), E08.649 — Diabetes mellitus due to underlying condition with hypoglycemia without coma (due to underlying condition, with, hypoglycemia), E08.65 — Diabetes mellitus due to underlying condition with hyperglycemia (due to underlying condition, with, hyperglycemia), E08.69 — Diabetes mellitus due to underlying condition with other specified complication (due to underlying condition, with, complication, specified NEC), E08.8 — Diabetes mellitus due to underlying condition with unspecified complications (due to underlying condition, with, complication), E08.9 — Diabetes mellitus due to underlying condition without complications (due to underlying condition), E10.10 — Type 1 diabetes mellitus with ketoacidosis without coma (type 1, with, ketoacidosis), E10.11 — Type 1 diabetes mellitus with ketoacidosis with coma (type 1, with, ketoacidosis, with coma), E10.21 — Type 1 diabetes mellitus with diabetic nephropathy (type 1, with, nephropathy), E10.22 — Type 1 diabetes mellitus with diabetic chronic kidney disease (type 1, with, chronic kidney disease), E10.29 — Type 1 diabetes mellitus with other diabetic kidney complication (type 1, with, renal complication NEC), E10.311 — Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema (type 1, with, retinopathy, with macular edema), E10.319 — Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema (type 1, with, retinopathy), E10.321 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema (type 1, with, retinopathy, nonproliferative, with macular edema), E10.329 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema (type 1, with, retinopathy, nonproliferative), E10.331 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema (type 1, with, retinopathy, nonproliferative, moderate, with macular edema), +192 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

HbA1c Test (Glycated Hemoglobin), Blood Glucose Test, Iron Panel, Lipid Panel, Thyroid Stimulating Hormone (TSH)

Contextual Map

Every relationship of E09.43 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run E09.43 with these 14 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes (23)

Referenced by Excludes2 notes

  • H35 — Other retinal disorders[Excludes2](via E09.-): “diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
  • I96 — Gangrene, not elsewhere classified[Excludes2](via E09.-): “gangrene in diabetes mellitus (E08-E13 with .52)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
  • K31 — Other diseases of stomach and duodenum[Excludes2]: “diabetic gastroparesis (E08.43, E09.43, E10.43, E11.43, E13.43)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Code First instructions

Referenced by Code Also instructions

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • Pre-MDC[MDC crossing]: “Pre-MDC — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 153 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
  • MDC 01 — Diseases and Disorders of the Nervous System[MDC crossing]: “Diseases and Disorders of the Nervous System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 8,892 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Diabetes, diabetic (mellitus) (sugar), due to drug or chemical, with, autonomicneuropathy (poly)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Diabetes, diabetic (mellitus) (sugar), due to drug or chemical, with, gastroparalysis[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Diabetes, diabetic (mellitus) (sugar), due to drug or chemical, with, gastroparesis[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "E09.43 — Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/e09.43-drug-or-chemical-induced-diabetes-mellitus-with-neurological-complications-with-diabetic-autonomic-polyneuropathy

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E09.43 in its code family, with their registry titles.

View all codes in the E09 family