ICD-10 Coding for Right Knee Replacement(M17.11, Z96.651)
Complete ICD-10-CM coding and documentation guide for Right Knee Replacement. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Knee Replacement
M17.0-M17.9Primary Range
Osteoarthritis of knee
This range includes codes for osteoarthritis, which is a common reason for knee replacement surgeries.
Presence of artificial knee joint
This range is used post-operatively to indicate the presence of a knee prosthesis.
ICD-10-PCS code for knee replacement procedures
This range includes procedural codes for the surgical replacement of the knee joint.
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 documenting primary osteoarthritis of the right knee leading to replacement. |
|
| Z96.651 | Presence of right artificial knee joint | Use post-operatively to indicate the presence of a knee prosthesis. |
|
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 right knee replacement
Essential facts and insights about Right Knee Replacement
Primary ICD-10-CM Codes for right knee replacement
Decision Criteria
clinical Criteria
- Confirmed diagnosis of primary osteoarthritis with imaging
Applicable To
- Primary osteoarthritis of the right knee
Excludes
- Post-traumatic osteoarthritis (M17.2)
Clinical Validation Requirements
- X-ray showing bone-on-bone articulation
- Failed conservative therapy for at least 6 months
Code-Specific Risks
- Ensure laterality is specified to avoid denials.
Coding Notes
- Ensure documentation supports the diagnosis with imaging and clinical history.
Z96.651 - Presence of right artificial knee joint
Use post-operatively to indicate the presence of a knee prosthesis.
Applicable To
- Status post right knee replacement
Clinical Validation Requirements
- Operative report confirming knee replacement
Coding Notes
Sequence after the primary diagnosis code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in right knee
M25.561Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Post-traumatic osteoarthritis, right knee
M17.2Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Right Knee Replacement to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M17.11.
Impact
Clinical: Inadequate assessment of patient progress., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Use specific pain scales (e.g., VAS), Document changes in pain with specific activities
Impact
Reimbursement: Incorrect sequencing can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Always sequence M17.11 first to indicate the underlying condition.
Impact
Failure to sequence codes correctly can lead to audits.
Mitigation Strategy
Regular training on coding guidelines and updates.
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 Right Knee Replacement, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Knee Replacement
Use these documentation templates to ensure complete and accurate documentation for Right Knee Replacement. These templates include all required elements for proper coding and billing.
Post-operative documentation for right knee replacement
Specialty: OrthopedicsRequired Elements
- Pain assessment
- Incision status
- Range of motion
- Weight-bearing status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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