ICD-10 Coding for Severe Osteoarthritis(M17.11, M17.5)
Complete ICD-10-CM coding and documentation guide for Severe Osteoarthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Severe Osteoarthritis
M15-M19Primary Range
Arthritis and polyarthritis
This range includes all types of osteoarthritis, including primary, secondary, and post-traumatic.
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 osteoarthritis is confirmed in the right knee without any underlying condition. |
|
| M17.5 | Secondary osteoarthritis of knee | Use when OA is secondary to another condition like obesity. |
|
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 severe osteoarthritis
Essential facts and insights about Severe Osteoarthritis
Primary ICD-10-CM Codes for severe osteoarthritis
Decision Criteria
clinical Criteria
- Radiographic evidence of OA in the right knee
documentation Criteria
- Specify laterality and type of OA
Applicable To
- Degenerative joint disease of right knee
Excludes
- Post-traumatic osteoarthritis (M17.31)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Osteophyte formation
Code-Specific Risks
- Ensure laterality is documented to avoid unspecified coding.
Coding Notes
- Ensure documentation specifies primary OA and laterality.
M17.5 - Secondary osteoarthritis of knee
Use when OA is secondary to another condition like obesity.
Applicable To
- OA due to obesity or trauma
Excludes
- Primary osteoarthritis (M17.0-M17.2)
Clinical Validation Requirements
- Documented underlying condition causing OA
Coding Notes
Sequence underlying condition first.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Presence of right artificial knee joint
Z96.651Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Severe 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: Misrepresentation of patient's condition., Regulatory: Potential audit issues., Financial: Incorrect reimbursement.
Mitigation Strategy
Thorough patient history, Link symptoms to underlying conditions
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always specify laterality and type of OA.
Impact
High risk of audits due to unspecified codes.
Mitigation Strategy
Ensure documentation specifies laterality and type.
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 Severe Osteoarthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Severe Osteoarthritis
Use these documentation templates to ensure complete and accurate documentation for Severe Osteoarthritis. These templates include all required elements for proper coding and billing.
Orthopedic evaluation for knee OA
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Radiographic evidence
- Functional impact
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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