ICD-10 Coding for Primary Osteoarthritis(M17.11, M17.12)
Complete ICD-10-CM coding and documentation guide for Primary Osteoarthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Primary Osteoarthritis
M15-M19Primary Range
Osteoarthritis
This range includes all codes related to osteoarthritis, with specific codes for primary osteoarthritis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M17.11 | Unilateral primary osteoarthritis, right knee | Use when primary osteoarthritis is confirmed in the right knee with no underlying cause. |
|
| M17.12 | Unilateral primary osteoarthritis, left knee | Use when primary osteoarthritis is confirmed in the left knee with no underlying cause. |
|
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 primary osteoarthritis
Essential facts and insights about Primary Osteoarthritis
Primary ICD-10-CM Codes for primary osteoarthritis
Decision Criteria
clinical Criteria
- Radiographic evidence of joint space narrowing in the right knee
documentation Criteria
- Documentation must specify 'primary' and 'right knee'
Applicable To
- Primary osteoarthritis of the right knee
Excludes
- Post-traumatic osteoarthritis (M17.31)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Symptoms of pain and stiffness in the right knee
Code-Specific Risks
- Incorrect laterality documentation
- Lack of radiographic evidence
Coding Notes
- Ensure documentation specifies laterality and confirms primary nature of osteoarthritis.
M17.12 - Unilateral primary osteoarthritis, left knee
Use when primary osteoarthritis is confirmed in the left knee with no underlying cause.
Applicable To
- Primary osteoarthritis of the left knee
Excludes
- Post-traumatic osteoarthritis (M17.32)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Symptoms of pain and stiffness in the left knee
Coding Notes
Ensure documentation specifies laterality and confirms 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 Primary Osteoarthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M17.11.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always include radiographic findings in the patient record.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Always document and code the specific knee affected (right or left).
Impact
Omissions in specifying laterality can lead to audit flags.
Mitigation Strategy
Implement mandatory fields for laterality in EHR systems.
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 Primary Osteoarthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Primary Osteoarthritis
Use these documentation templates to ensure complete and accurate documentation for Primary Osteoarthritis. These templates include all required elements for proper coding and billing.
Primary osteoarthritis of the knee
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Radiographic evidence
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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