ICD-10 Coding for Osteoarthritis of the Knee(M17.0, M17.11)
Complete ICD-10-CM coding and documentation guide for Osteoarthritis of the Knee. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Osteoarthritis of the Knee
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, confirmed by imaging. |
|
| 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 Osteoarthritis of the Knee
Primary ICD-10-CM Codes for osteoarthritis knee
Decision Criteria
clinical Criteria
- Bilateral knee pain with radiographic evidence of osteoarthritis
Applicable To
- Degenerative joint disease of both knees
Clinical Validation Requirements
- Radiographic evidence of bilateral joint space narrowing and osteophytes
Code-Specific Risks
- Avoid use if only one knee is affected or if the cause is post-traumatic.
Coding Notes
- Ensure bilateral involvement is confirmed by imaging.
M17.11 - Unilateral primary osteoarthritis, right knee
Use when only the right knee is affected by primary osteoarthritis.
Applicable To
- Degenerative joint disease of right knee
Excludes
- Post-traumatic osteoarthritis (M17.3-M17.5)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing and osteophytes in the right knee
Coding Notes
Ensure laterality is documented as right.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Osteoarthritis of the 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: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Always include imaging results in the patient record.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Decreases the accuracy of clinical data.
Mitigation Strategy
Always specify laterality (right, left, bilateral) when documented.
Impact
Failure to document laterality can lead to audit flags.
Mitigation Strategy
Implement a checklist to ensure laterality is documented.
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 Osteoarthritis of the Knee, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Osteoarthritis of the Knee
Use these documentation templates to ensure complete and accurate documentation for Osteoarthritis of the Knee. These templates include all required elements for proper coding and billing.
Primary OA with planned TKR
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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