ICD-10 Coding for Knee Osteoarthritis(M17.0, M17.11)
Complete ICD-10-CM coding and documentation guide for Knee Osteoarthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Knee Osteoarthritis
M17.0-M17.9Primary Range
Osteoarthritis of knee
This range includes all primary and secondary osteoarthritis codes specific to the knee, covering bilateral, unilateral, and unspecified cases.
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 both knees are affected by primary osteoarthritis. |
|
| M17.11 | Unilateral primary osteoarthritis, right knee | Use when only the right knee is affected by primary osteoarthritis. |
|
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 osteoarthritis
Essential facts and insights about Knee Osteoarthritis
Primary ICD-10-CM Codes for knee osteoarthritis
Decision Criteria
clinical Criteria
- Radiographic evidence and clinical symptoms confirm diagnosis.
Applicable To
- Primary osteoarthritis affecting both knees
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing and osteophytes
- Clinical symptoms such as pain and stiffness
Code-Specific Risks
- Ensure laterality is specified to avoid denials.
Coding Notes
- Ensure to document the primary nature of osteoarthritis and specify bilateral involvement.
M17.11 - Unilateral primary osteoarthritis, right knee
Use when only the right knee is affected by primary osteoarthritis.
Applicable To
- Primary osteoarthritis affecting the right knee
Excludes
- Post-traumatic osteoarthritis (M17.2-M17.3)
Clinical Validation Requirements
- Radiographic evidence specific to the right knee
- Clinical symptoms such as localized pain
Coding Notes
Document specific laterality and primary nature of osteoarthritis.
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 Osteoarthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M17.0.
Impact
Clinical: Misrepresents the patient's condition., Regulatory: Non-compliance with coding guidelines., Financial: Potential for claim denials.
Mitigation Strategy
Only use pain codes if pain is unrelated to osteoarthritis., Review documentation for clear linkage.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Query provider for specific laterality to ensure accurate coding.
Impact
Failure to document laterality can lead to audit findings.
Mitigation Strategy
Implement mandatory laterality checks in documentation workflows.
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 Osteoarthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Knee Osteoarthritis
Use these documentation templates to ensure complete and accurate documentation for Knee Osteoarthritis. These templates include all required elements for proper coding and billing.
Initial evaluation of knee osteoarthritis
Specialty: OrthopedicsRequired Elements
- Patient history
- 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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