ICD-10 Coding for Bilateral Primary Osteoarthritis of Knee(M17.0)
Complete ICD-10-CM coding and documentation guide for Bilateral Primary Osteoarthritis of Knee. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Bilateral Primary Osteoarthritis of Knee
M15-M19Primary Range
Osteoarthritis
This range includes all types of osteoarthritis, with M17.0 specifically for bilateral primary osteoarthritis of the knee.
Key Information: ICD-10 code for bilateral primary osteoarthritis of knee
Essential facts and insights about Bilateral Primary Osteoarthritis of Knee
Primary ICD-10-CM Code for bilateral primary osteoarthritis of knee
Decision Criteria
clinical Criteria
- Confirmed bilateral knee involvement with primary osteoarthritis features on imaging
documentation Criteria
- Explicit mention of 'bilateral primary osteoarthritis' in medical records
Applicable To
- Degenerative joint disease of both knees
Clinical Validation Requirements
- X-ray findings showing joint space narrowing, osteophytes, or subchondral sclerosis
- Clinical symptoms such as pain and stiffness in both knees
Code-Specific Risks
- Misclassification if secondary causes are not ruled out
Coding Notes
- Ensure documentation specifies 'primary' and 'bilateral' to avoid unspecified codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in right knee
M25.561Pain in left knee
M25.562Body mass index (BMI) 30.0-39.9 or ≥40
Z68.3-Z68.4Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Bilateral Primary Osteoarthritis of Knee to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M17.0.
Impact
Clinical: Leads to potential misdiagnosis or inappropriate treatment plans., Regulatory: May result in coding audits or compliance issues., Financial: Could affect reimbursement rates due to unspecified coding.
Mitigation Strategy
Educate providers on the importance of specifying 'primary' in documentation, Implement EHR prompts for specificity
Impact
Reimbursement: Incorrect coding can lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Code M17.11 (right) + Z96.642 (left TKA)
Impact
Using M17.9 when M17.0 is applicable
Mitigation Strategy
Educate coding staff on the importance of specificity and provide regular training.
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 Primary Osteoarthritis of Knee, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Bilateral Primary Osteoarthritis of Knee
Use these documentation templates to ensure complete and accurate documentation for Bilateral Primary Osteoarthritis of Knee. These templates include all required elements for proper coding and billing.
Pre-TKA Evaluation
Specialty: OrthopedicsRequired Elements
- History of knee pain
- Physical examination findings
- Imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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