ICD-10 Coding for Patellofemoral Pain Syndrome(M22.2X1, M22.2X2)
Complete ICD-10-CM coding and documentation guide for Patellofemoral Pain Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Patellofemoral Pain Syndrome
M22.2XPrimary Range
Disorders of patella, unspecified
This range includes codes specific to patellofemoral pain syndrome with laterality.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M22.2X1 | Disorders of patella, right knee | Use when PFPS is confirmed in the right knee with specific clinical findings. |
|
| M22.2X2 | Disorders of patella, left knee | Use when PFPS is confirmed in the left knee with specific clinical findings. |
|
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 patellofemoral pain syndrome
Essential facts and insights about Patellofemoral Pain Syndrome
Primary ICD-10-CM Codes for patellofemoral pain syndrome
Decision Criteria
clinical Criteria
- Presence of retropatellar pain exacerbated by specific activities.
documentation Criteria
- Detailed description of pain location and activity-related exacerbation.
Applicable To
- Patellofemoral pain syndrome, right knee
Excludes
- Chondromalacia patellae (M22.4-)
Clinical Validation Requirements
- Pain during squatting or stair climbing
- Positive patellar grind test
Code-Specific Risks
- Incorrectly coding general knee pain as PFPS without specific findings.
Coding Notes
- Ensure documentation supports PFPS-specific symptoms and excludes other conditions.
M22.2X2 - Disorders of patella, left knee
Use when PFPS is confirmed in the left knee with specific clinical findings.
Applicable To
- Patellofemoral pain syndrome, left knee
Excludes
- Chondromalacia patellae (M22.4-)
Clinical Validation Requirements
- Pain during squatting or stair climbing
- Positive patellar grind test
Coding Notes
Ensure documentation supports PFPS-specific symptoms and excludes other conditions.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Muscle weakness (generalized)
M62.81-Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Chondromalacia patellae
M22.4-Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Patellofemoral Pain Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M22.2X1.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Increases risk of audit failures., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Use specific terms and document clinical findings.
Impact
Reimbursement: May result in lower reimbursement due to incorrect DRG assignment., Compliance: Could lead to compliance issues during audits., Data Quality: Impacts the accuracy of clinical data and patient records.
Mitigation Strategy
Ensure documentation includes PFPS-specific symptoms and tests.
Impact
Failure to specify laterality can lead to audit issues.
Mitigation Strategy
Always document and code the specific knee affected.
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 Patellofemoral Pain Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Patellofemoral Pain Syndrome
Use these documentation templates to ensure complete and accurate documentation for Patellofemoral Pain Syndrome. These templates include all required elements for proper coding and billing.
Orthopedic Evaluation for PFPS
Specialty: OrthopedicsRequired Elements
- Pain location and exacerbating activities
- Physical exam findings
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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