ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 E10.21

Billable / Specific

Type 1 diabetes mellitus with diabetic nephropathy

E10
Block
3
Synonyms
210
LCDs
32
Payer Policies
56
Linked CPTs

About ICD-10-CM E10.21

ICD-10-CM code E10.21 represents Type 1 diabetes mellitus with diabetic nephropathy. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E10). The 2026 edition of ICD-10-CM E10.21 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under E10.21. Per CMS ICD-10-CM Tabular 2026.

  • Type 1 diabetes mellitus with intercapillary glomerulosclerosis
  • Type 1 diabetes mellitus with intracapillary glomerulonephrosis
  • Type 1 diabetes mellitus with Kimmelstiel-Wilson disease

Medicare Advantage HCC Impact

ESRD-HCC
Category 141

Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.

Medicare LCD Coverage for E10.21

Local Coverage Determinations (LCDs) from CMS MACs that list E10.21 as a covered diagnosis.

210 LCDs

Showing top 10 of 210 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)
Article ID: 58213, Effective: 2025-04-01 00:00:00, 373 covered, 1 non-covered
CPT 0446T →
CMS LCD: Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)
Article ID: 58213, Effective: 2025-04-01 00:00:00, 373 covered, 1 non-covered
CPT 0448T →
CMS LCD: Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)
Article ID: 58213, Effective: 2025-04-01 00:00:00, 373 covered, 1 non-covered
CPT 0447T →
CMS LCD: Billing and Coding: Homocysteine Level, Serum
Article ID: 56675, Effective: 2024-10-01 00:00:00, 550 covered, 0 non-covered
CPT 83090 →
CMS LCD: Billing and Coding: Cardiac Radionuclide Imaging
Article ID: 56476, Effective: 2025-10-01 00:00:00, 627 covered, 0 non-covered
CPT A4641 →
CMS LCD: Billing and Coding: Cardiac Radionuclide Imaging
Article ID: 56476, Effective: 2025-10-01 00:00:00, 627 covered, 0 non-covered
CPT J0461 →
CMS LCD: Billing and Coding: Cardiac Radionuclide Imaging
Article ID: 56476, Effective: 2025-10-01 00:00:00, 627 covered, 0 non-covered
CPT A9611 →
CMS LCD: Billing and Coding: Cardiac Radionuclide Imaging
Article ID: 56476, Effective: 2025-10-01 00:00:00, 627 covered, 0 non-covered
CPT 78454 →
CMS LCD: Billing and Coding: Cardiac Radionuclide Imaging
Article ID: 56476, Effective: 2025-10-01 00:00:00, 627 covered, 0 non-covered
CPT J1245 →
CMS LCD: Billing and Coding: Cardiac Radionuclide Imaging
Article ID: 56476, Effective: 2025-10-01 00:00:00, 627 covered, 0 non-covered
CPT 78453 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing E10.21.

32 policies

1 Cigna

Vitamin D Testing - (0526) ---- future effective policy
Policy ID: MM_0526

5 Medicare

Glucose Monitor - Policy Article
Policy ID: ART-52464
Therapeutic Shoes for Persons with Diabetes - Policy Article
Policy ID: ART-52501
External Infusion Pumps - Policy Article
Policy ID: ART-52507
Billing and Coding: Routine Foot Care
Policy ID: ART-52996
Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity
Policy ID: ART-54923

CPT Codes Commonly Billed with E10.21

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

56 linkages
  • 51741 CMS LCD: Billing and Coding: Urodynamics CMS LCD
  • 51728 CMS LCD: Billing and Coding: Urodynamics CMS LCD
  • 51729 CMS LCD: Billing and Coding: Urodynamics CMS LCD
  • 55899 CMS LCD: Billing and Coding: Urodynamics CMS LCD
  • 51792 CMS LCD: Billing and Coding: Urodynamics CMS LCD
  • 51736 CMS LCD: Billing and Coding: Urodynamics CMS LCD
  • 51726 CMS LCD: Billing and Coding: Urodynamics CMS LCD
  • 51727 CMS LCD: Billing and Coding: Urodynamics CMS LCD
  • 51797 CMS LCD: Billing and Coding: Urodynamics CMS LCD
  • 01782 CMS LCD: Billing and Coding: Monitored Anesthesia Care CMS LCD

Convert E10.21 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
E10.21 25041 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

Codes Adjacent To E10.21

Other codes in section E08-E13 (Diabetes mellitus).

E08 Diabetes mellitus due to underlying condition (non-billable) E08.0 Diabetes mellitus due to underlying condition with hyperosmolarity (non-billable) E08.00 Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) E08.01 Diabetes mellitus due to underlying condition with hyperosmolarity with coma E08.1 Diabetes mellitus due to underlying condition with ketoacidosis (non-billable) E08.10 Diabetes mellitus due to underlying condition with ketoacidosis without coma E08.11 Diabetes mellitus due to underlying condition with ketoacidosis with coma E08.2 Diabetes mellitus due to underlying condition with kidney complications (non-billable) E08.21 Diabetes mellitus due to underlying condition with diabetic nephropathy E08.22 Diabetes mellitus due to underlying condition with diabetic chronic kidney disease E08.29 Diabetes mellitus due to underlying condition with other diabetic kidney complication E08.3 Diabetes mellitus due to underlying condition with ophthalmic complications (non-billable) E08.31 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy (non-billable) E08.311 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema E08.319 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema E08.32 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy (non-billable) E08.321 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema (non-billable) E08.329 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema (non-billable) E08.33 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy (non-billable) E08.331 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema (non-billable)

ICD-10 E10.21, Billing FAQ

Is ICD-10 code E10.21 billable? +

Yes, E10.21 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to E10.21? +

ICD-10 E10.21 includes: Type 1 diabetes mellitus with intercapillary glomerulosclerosis; Type 1 diabetes mellitus with intracapillary glomerulonephrosis; Type 1 diabetes mellitus with Kimmelstiel-Wilson disease.

What CPT codes are commonly billed with E10.21? +

Procedures frequently paired with E10.21 include: 51741, 51728, 51729, 55899, 51792.

What ICD-9 codes does E10.21 map to? +

Per CMS GEMs, E10.21 maps to ICD-9 codes: 25041. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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