ICD-10 Coding for Chondromalacia(M22.41, M22.42, M94.261, M94.262)
Complete ICD-10-CM coding and documentation guide for Chondromalacia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Chondromalacia
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M22.41 | Chondromalacia patellae, right knee | Use when the condition specifically affects the right patella. |
|
| M22.42 | Chondromalacia patellae, left knee | Use when the condition specifically affects the left patella. |
|
| M94.261 | Chondromalacia, right knee | Use for non-patellar cartilage degeneration in the right knee. |
|
| M94.262 | Chondromalacia, left knee | Use for non-patellar cartilage degeneration in the left knee. |
|
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 chondromalacia patellae
Essential facts and insights about Chondromalacia
Primary ICD-10-CM Codes for chondromalacia
Decision Criteria
clinical Criteria
- MRI shows patellar cartilage softening
Applicable To
- Patellar cartilage softening
Excludes
- Chondromalacia of femoral condyles
Clinical Validation Requirements
- MRI showing patellar cartilage defects
- Positive patellar compression test
Code-Specific Risks
- Incorrectly coding for non-patellar chondromalacia
Coding Notes
- Ensure documentation specifies patellar involvement.
M22.42 - Chondromalacia patellae, left knee
Use when the condition specifically affects the left patella.
Applicable To
- Patellar cartilage softening
Excludes
- Chondromalacia of femoral condyles
Clinical Validation Requirements
- MRI showing patellar cartilage defects
- Positive patellar compression test
Coding Notes
Ensure documentation specifies patellar involvement.
M94.261 - Chondromalacia, right knee
Use for non-patellar cartilage degeneration in the right knee.
Applicable To
- Non-patellar cartilage degeneration
Excludes
- Chondromalacia patellae
Clinical Validation Requirements
- MRI showing femoral or tibial cartilage defects
Coding Notes
Ensure documentation specifies non-patellar involvement.
M94.262 - Chondromalacia, left knee
Use for non-patellar cartilage degeneration in the left knee.
Applicable To
- Non-patellar cartilage degeneration
Excludes
- Chondromalacia patellae
Clinical Validation Requirements
- MRI showing femoral or tibial cartilage defects
Coding Notes
Ensure documentation specifies non-patellar involvement.
Differential 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 Chondromalacia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M22.41.
Impact
Clinical: May lead to misdiagnosis or incorrect treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials or audits.
Mitigation Strategy
Include specific clinical tests and imaging findings, Detail the exact location of cartilage damage
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data and reporting.
Mitigation Strategy
Use M22.4x for patellar-specific cases
Impact
Using M94.26x for patellar chondromalacia
Mitigation Strategy
Educate providers on code differentiation and documentation requirements.
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 Chondromalacia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Chondromalacia
Use these documentation templates to ensure complete and accurate documentation for Chondromalacia. These templates include all required elements for proper coding and billing.
Orthopedic evaluation for chondromalacia patellae
Specialty: OrthopedicsRequired Elements
- Subjective: Patient's description of symptoms
- Objective: Physical exam findings
- Assessment: Diagnosis with ICD-10 code
- Plan: Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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