ICD-10 Coding for Degenerative Joint Disease(M17.11, M16.12)
Complete ICD-10-CM coding and documentation guide for Degenerative Joint Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Degenerative Joint Disease
M15-M19Primary Range
Osteoarthritis
This range includes all forms of osteoarthritis, which is synonymous with degenerative joint disease.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M17.11 | Unilateral primary osteoarthritis, right knee | Use when there is confirmed primary osteoarthritis in the right knee with specific radiographic findings. |
|
| M16.12 | Bilateral primary osteoarthritis of hip | Use when there is confirmed primary osteoarthritis in both hips. |
|
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 degenerative joint disease
Essential facts and insights about Degenerative Joint Disease
Primary ICD-10-CM Codes for degenerative joint disease
Decision Criteria
clinical Criteria
- Radiographic evidence of osteoarthritis
documentation Criteria
- Specific mention of 'primary osteoarthritis' and 'right knee'
Applicable To
- Primary osteoarthritis of right knee
Excludes
- Post-traumatic osteoarthritis (M19.11)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing ≥2mm
- Patient reports knee pain and stiffness
Code-Specific Risks
- Risk of under-documentation if laterality is not specified.
Coding Notes
- Ensure documentation specifies laterality and primary nature of osteoarthritis.
M16.12 - Bilateral primary osteoarthritis of hip
Use when there is confirmed primary osteoarthritis in both hips.
Applicable To
- Primary osteoarthritis of both hips
Excludes
- Secondary osteoarthritis of hip (M16.5)
Clinical Validation Requirements
- Radiographic evidence of osteophytes and joint space narrowing
- Patient reports bilateral hip pain
Coding Notes
Ensure documentation specifies bilateral involvement.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in right knee
M25.561Differential 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 Degenerative Joint Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M17.11.
Impact
Clinical: May lead to incorrect treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Always document the specific joint affected., Use templates that prompt for laterality.
Impact
Reimbursement: Potential for reduced reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Decreased accuracy in health records.
Mitigation Strategy
Always use the most specific code available, specifying laterality and primary vs. secondary nature.
Impact
Risk of audits due to use of unspecified codes.
Mitigation Strategy
Ensure documentation supports the most specific code possible.
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 Degenerative Joint Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Degenerative Joint Disease
Use these documentation templates to ensure complete and accurate documentation for Degenerative Joint Disease. These templates include all required elements for proper coding and billing.
Orthopedic follow-up for knee osteoarthritis
Specialty: OrthopedicsRequired Elements
- Patient-reported symptoms
- Radiographic findings
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Degenerative Joint Disease? Ask your questions below.