ICD-10 Coding for Knee Chondromalacia(M94.261, M94.262, M22.4)
Complete ICD-10-CM coding and documentation guide for Knee Chondromalacia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Knee 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 |
|---|---|---|---|
| M94.261 | Chondromalacia, right knee | Use when chondromalacia affects non-patellar areas of the right knee. |
|
| M94.262 | Chondromalacia, left knee | Use when chondromalacia affects non-patellar areas of the left knee. |
|
| M22.4 | Chondromalacia patellae | Use when chondromalacia is isolated to the patella. |
|
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 left knee chondromalacia
Essential facts and insights about Knee Chondromalacia
Primary ICD-10-CM Codes for knee chondromalacia
Decision Criteria
clinical Criteria
- MRI confirms cartilage damage in non-patellar areas.
documentation Criteria
- Documentation specifies 'right knee' and non-patellar location.
Applicable To
- Chondromalacia of the medial femoral condyle
- Chondromalacia of the lateral femoral condyle
Excludes
- Chondromalacia patellae (M22.4)
Clinical Validation Requirements
- MRI showing cartilage damage outside patella
- Pain localized to medial/lateral knee
Code-Specific Risks
- Mixing with M22.4 codes when patellar involvement is present
Coding Notes
- Ensure documentation specifies the exact location and laterality.
M94.262 - Chondromalacia, left knee
Use when chondromalacia affects non-patellar areas of the left knee.
Applicable To
- Chondromalacia of the medial femoral condyle
- Chondromalacia of the lateral femoral condyle
Excludes
- Chondromalacia patellae (M22.4)
Clinical Validation Requirements
- MRI showing cartilage damage outside patella
- Pain localized to medial/lateral knee
Coding Notes
Ensure documentation specifies the exact location and laterality.
M22.4 - Chondromalacia patellae
Use when chondromalacia is isolated to the patella.
Applicable To
- Patellar cartilage damage
Excludes
- Chondromalacia of other knee areas (M94.26)
Clinical Validation Requirements
- Pain worsens with stairs/squatting
- Crepitus on patellar compression
Coding Notes
Ensure documentation specifies patellar involvement.
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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Knee Chondromalacia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M94.261.
Impact
Clinical: Leads to inadequate treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to lack of specificity.
Mitigation Strategy
Use templates that prompt for specific details., Educate providers on documentation requirements.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with ICD-10 coding rules., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M94.26 as it includes patellar involvement when other sites are affected.
Impact
Incorrect selection between M94.26 and M22.4 codes.
Mitigation Strategy
Educate coders on the differences and ensure documentation supports code selection.
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 Knee Chondromalacia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Knee Chondromalacia
Use these documentation templates to ensure complete and accurate documentation for Knee Chondromalacia. These templates include all required elements for proper coding and billing.
Orthopedic Progress Note
Specialty: OrthopedicsRequired Elements
- Subjective symptoms
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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