ICD-10 Coding for Bilateral Knee Replacement(M17.0, Z96.651, Z96.652)
Complete ICD-10-CM coding and documentation guide for Bilateral Knee Replacement. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Bilateral Knee Replacement
M17.0-M17.9Primary Range
Osteoarthritis of knee
This range includes codes for osteoarthritis of the knee, which is the primary condition leading to knee replacement.
Presence of artificial knee joint
These codes indicate the status of a knee replacement, important for follow-up care and documentation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M17.0 | Bilateral primary osteoarthritis of knee | Use when documenting primary osteoarthritis affecting both knees. |
|
| Z96.651 | Presence of right artificial knee joint | Use for follow-up visits post right knee replacement. |
|
| Z96.652 | Presence of left artificial knee joint | Use for follow-up visits post left knee replacement. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for bilateral knee replacement
Essential facts and insights about Bilateral Knee Replacement
Primary ICD-10-CM Codes for bilateral knee replacement
Decision Criteria
clinical Criteria
- Radiographic evidence of bilateral joint space narrowing
documentation Criteria
- Detailed history of conservative treatment failure
Applicable To
- Bilateral knee osteoarthritis
Excludes
- Post-traumatic osteoarthritis (M23.2)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Clinical history of chronic knee pain
Code-Specific Risks
- Ensure bilateral involvement is documented to avoid incorrect coding.
Coding Notes
- Ensure documentation supports bilateral involvement and primary osteoarthritis.
Z96.651 - Presence of right artificial knee joint
Use for follow-up visits post right knee replacement.
Applicable To
- Right knee prosthesis
Excludes
- Infection and inflammatory reaction due to internal joint prosthesis (T84.5-)
Clinical Validation Requirements
- Surgical history confirming knee replacement
- Physical examination confirming prosthetic presence
Coding Notes
Verify surgical history and prosthetic status.
Z96.652 - Presence of left artificial knee joint
Use for follow-up visits post left knee replacement.
Applicable To
- Left knee prosthesis
Excludes
- Infection and inflammatory reaction due to internal joint prosthesis (T84.5-)
Clinical Validation Requirements
- Surgical history confirming knee replacement
- Physical examination confirming prosthetic presence
Coding Notes
Verify surgical history and prosthetic status.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Derangement of meniscus due to old tear or injury
M23.2Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Bilateral Knee Replacement to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M17.0.
Impact
Clinical: May lead to incorrect treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document laterality in clinical notes., Use specific codes for right and left prostheses.
Impact
Reimbursement: Incorrect coding may lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records affecting clinical decisions.
Mitigation Strategy
Use M17.0 to specify bilateral primary osteoarthritis.
Impact
Incorrect use of modifiers for bilateral procedures.
Mitigation Strategy
Ensure documentation supports the use of modifier 50.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Bilateral Knee Replacement, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Bilateral Knee Replacement
Use these documentation templates to ensure complete and accurate documentation for Bilateral Knee Replacement. These templates include all required elements for proper coding and billing.
Pre-operative Assessment for Bilateral TKA
Specialty: OrthopedicsRequired Elements
- Detailed pain assessment
- Conservative treatment history
- Functional limitations
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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