Endocrine, Nutritional and Metabolic Diseases

ICD-10 Code: E11.22

Type 2 Diabetes Mellitus with Diabetic Chronic Kidney Disease

Type 2 diabetes mellitus with chronic kidney disease (CKD) represents progressive kidney damage caused by longstanding diabetes, characterized by persistent albuminuria and/or declining glomerular filtration rate (GFR) attributable to diabetic nephropathy.

Clinical Information

Diabetic chronic kidney disease (CKD) is a serious microvascular complication affecting approximately 20-40% of patients with type 2 diabetes and is the leading cause of end-stage renal disease (ESRD) in the United States. Diabetic nephropathy develops through a complex pathophysiology involving hyperglycemia-induced glomerular hyperfiltration, mesangial expansion, basement membrane thickening, and progressive glomerulosclerosis. The clinical course typically progresses through stages: initial hyperfiltration (normal or elevated GFR), microalbuminuria (30-300 mg/day), macroalbuminuria (>300 mg/day), declining GFR, and eventual renal failure. Early stages may be asymptomatic, detected only through screening urinalysis and serum creatinine/GFR measurements. Risk factors include poor glycemic control, hypertension, family history of kidney disease, longer diabetes duration, and certain ethnic backgrounds (African American, Hispanic, Native American). Management focuses on glycemic control, blood pressure control (especially with ACE inhibitors or ARBs), and monitoring disease progression.

Coding Guidelines

  • 1Use additional code to identify stage of chronic kidney disease (N18.1-N18.6) - this is REQUIRED per ICD-10-CM guidelines
  • 2Code E11.22 is used when diabetic nephropathy or CKD is documented as being caused by diabetes
  • 3If patient has both diabetes and CKD but causality is not established, code separately (E11.9 and N18.x)
  • 4Do not assume causality; provider must link the CKD to diabetes in documentation
  • 5For patients on dialysis, use additional code Z99.2 (dependence on renal dialysis)
  • 6For kidney transplant status, add Z94.0

Common Uses

  • Annual diabetic screening reveals new-onset microalbuminuria with GFR 55 mL/min
  • Follow-up for established diabetic CKD with monitoring of kidney function
  • Nephrologist visit for progressive diabetic nephropathy requiring treatment adjustment
  • Hospitalization for acute on chronic kidney injury in diabetic patient
  • Initiation of dialysis in patient with diabetes-induced ESRD
  • Pre-operative clearance documenting diabetic CKD as comorbidity

Related ICD-10 Codes

N18.1Chronic kidney disease, stage 1 (use additional code)
N18.2Chronic kidney disease, stage 2
N18.3Chronic kidney disease, stage 3
N18.4Chronic kidney disease, stage 4
N18.5Chronic kidney disease, stage 5
N18.6End stage renal disease
E11.9Type 2 diabetes without complications
Z99.2Dependence on renal dialysis

Documentation Requirements

  • Provider must explicitly document causal relationship: 'diabetic kidney disease,' 'diabetic nephropathy,' or 'CKD due to diabetes'
  • Document specific CKD stage based on GFR (Stage 1: ≥90, Stage 2: 60-89, Stage 3: 30-59, Stage 4: 15-29, Stage 5: <15 mL/min/1.73m²)
  • Include albuminuria status if available (urine albumin-to-creatinine ratio or 24-hour protein)
  • Most recent serum creatinine and calculated GFR/eGFR
  • Document dialysis dependence if applicable
  • Current treatment regimen (ACE inhibitor, ARB, dietary restrictions, etc.)

Real-World Coding Examples

Patient with 15-year history of type 2 diabetes presents for follow-up. Labs show serum creatinine 2.1 mg/dL, eGFR 32 mL/min/1.73m², urine albumin-to-creatinine ratio 450 mg/g. Diagnosis: Type 2 diabetes with diabetic chronic kidney disease, stage 3b (E11.22, N18.3).

Nephrologist visit for diabetic patient. Documentation states 'diabetic nephropathy with declining renal function.' eGFR 22 mL/min. Diagnosis: Type 2 diabetes mellitus with diabetic CKD, stage 4 (E11.22, N18.4). Plan: Pre-dialysis education.

68-year-old with diabetes presents to ED with uremia symptoms. Creatinine 8.5 mg/dL, eGFR 8 mL/min. Admitted for dialysis catheter placement. Diagnosis: Type 2 diabetes with diabetic ESKD (E11.22, N18.6). Dialysis initiated.

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Medical coding for Endocrine, Nutritional and Metabolic Diseases