ICD-10 Coding for Patellofemoral Syndrome(M22.2X1, M22.2X2, M22.2X9, M22.4)
Complete ICD-10-CM coding and documentation guide for Patellofemoral Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Patellofemoral Syndrome
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 | Patellofemoral disorders, right knee | Use when the patient presents with patellofemoral pain in the right knee, confirmed by clinical tests and/or imaging. |
|
| M22.2X2 | Patellofemoral disorders, left knee | Use when the patient presents with patellofemoral pain in the left knee, confirmed by clinical tests and/or imaging. |
|
| M22.2X9 | Patellofemoral disorders, unspecified knee | Use when the laterality of the patellofemoral disorder is not specified. |
|
| M22.4 | Chondromalacia patellae | Use when there is documented evidence of chondromalacia of 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 patellofemoral syndrome
Essential facts and insights about Patellofemoral Syndrome
Primary ICD-10-CM Codes for patellofemoral syndrome
Decision Criteria
clinical Criteria
- Presence of retropatellar pain and positive patellar grind test.
coding Criteria
- Specify laterality to avoid unspecified codes.
Applicable To
- Retropatellar pain
- Peripatellar pain
Excludes
- Traumatic dislocation of patella (S83.0)
Clinical Validation Requirements
- Positive patellar grind test
- Imaging showing maltracking
Code-Specific Risks
- Confusion with traumatic conditions
- Incorrect laterality
Coding Notes
- Ensure laterality is specified to avoid unspecified codes.
M22.2X2 - Patellofemoral disorders, left knee
Use when the patient presents with patellofemoral pain in the left knee, confirmed by clinical tests and/or imaging.
Applicable To
- Retropatellar pain
- Peripatellar pain
Excludes
- Traumatic dislocation of patella (S83.0)
Clinical Validation Requirements
- Positive patellar grind test
- Imaging showing maltracking
Coding Notes
Ensure laterality is specified to avoid unspecified codes.
M22.2X9 - Patellofemoral disorders, unspecified knee
Use when the laterality of the patellofemoral disorder is not specified.
Applicable To
- Retropatellar pain
- Peripatellar pain
Excludes
- Traumatic dislocation of patella (S83.0)
Clinical Validation Requirements
- Positive patellar grind test
- Imaging showing maltracking
Coding Notes
Use only when laterality cannot be determined.
M22.4 - Chondromalacia patellae
Use when there is documented evidence of chondromalacia of the patella.
Applicable To
- Cartilage degeneration of the patella
Excludes
- Chondromalacia elsewhere (M94.26)
Clinical Validation Requirements
- MRI showing cartilage degeneration
- Positive clinical tests for chondromalacia
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 Patellofemoral 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 issues., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Use specific terms like 'retropatellar pain', Include detailed physical exam findings
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation specifies whether chondromalacia is present.
Impact
Reimbursement: Unspecified codes may result in lower reimbursement., Compliance: Potential audit issues due to lack of specificity., Data Quality: Decreased accuracy in patient records.
Mitigation Strategy
Always document and code the specific knee affected.
Impact
Failure to specify laterality can lead to audit flags.
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 Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Patellofemoral Syndrome
Use these documentation templates to ensure complete and accurate documentation for Patellofemoral Syndrome. These templates include all required elements for proper coding and billing.
Orthopedic evaluation of patellofemoral syndrome
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Functional test outcomes
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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