ICD-10 Coding for Pain in the Right Knee(M25.561, M17.11, M23.21)
Complete ICD-10-CM coding and documentation guide for Pain in the Right Knee. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pain in the Right Knee
M25.5Primary Range
Pain in joint
This range includes codes for pain in specific joints, including the knee.
Internal derangement of knee
This range is used when knee pain is due to ligament or meniscal injuries.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M25.561 | Pain in right knee | Use when the patient presents with right knee pain and no specific underlying condition is identified. |
|
| M17.11 | Unilateral primary osteoarthritis, right knee | Use when osteoarthritis is the confirmed cause of knee pain. |
|
| M23.21 | Derangement of anterior cruciate ligament, right knee | Use when an ACL injury is confirmed as the cause of knee pain. |
|
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 pain in the right knee
Essential facts and insights about Pain in the Right Knee
Primary ICD-10-CM Codes for pain in the right knee
Decision Criteria
clinical Criteria
- Pain localized to the right knee without specific diagnosis
coding Criteria
- No trauma or specific condition identified
documentation Criteria
- Documentation must specify 'right knee' and describe pain characteristics
Applicable To
- Localized pain in right knee
Excludes
- Pain due to known conditions like osteoarthritis or ligament injuries
Clinical Validation Requirements
- Clinical notes specifying 'right knee pain' without known etiology
- Exclusion of trauma or specific pathology
Code-Specific Risks
- Risk of using unspecified codes when laterality is known
Coding Notes
- Ensure documentation specifies 'right knee' to avoid unspecified coding.
M17.11 - Unilateral primary osteoarthritis, right knee
Use when osteoarthritis is the confirmed cause of knee pain.
Applicable To
- Osteoarthritis confirmed by imaging
Excludes
- Pain not due to osteoarthritis
Clinical Validation Requirements
- X-ray or MRI showing joint space narrowing, osteophytes
Coding Notes
Ensure imaging results are documented to support osteoarthritis diagnosis.
M23.21 - Derangement of anterior cruciate ligament, right knee
Use when an ACL injury is confirmed as the cause of knee pain.
Applicable To
- ACL tear confirmed by MRI
Excludes
- Pain not due to ligament injury
Clinical Validation Requirements
- MRI report confirming ACL tear
Coding Notes
Ensure MRI findings are documented to support ligament injury diagnosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic pain syndrome
G89.21Differential 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 Pain in the Right Knee to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.561.
Impact
Clinical: May lead to incorrect treatment plans., Regulatory: Increases risk of audit issues., Financial: Potential for claim denials.
Mitigation Strategy
Ensure imaging results are included in documentation.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Compromises data accuracy for clinical analysis.
Mitigation Strategy
Always specify 'right knee' in documentation to use M25.561.
Impact
Using unspecified codes when specific codes are available.
Mitigation Strategy
Ensure documentation specifies laterality and underlying conditions.
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 Pain in the Right Knee, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pain in the Right Knee
Use these documentation templates to ensure complete and accurate documentation for Pain in the Right Knee. These templates include all required elements for proper coding and billing.
Chronic right knee pain due to osteoarthritis
Specialty: OrthopedicsRequired Elements
- Location: Right knee
- Onset: Gradual over 6 months
- Aggravators: Stair climbing
- Imaging: X-ray showing osteoarthritis
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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