In this article will study on ICD 10 Code for Knee Pain, Bilateral Knee Pain (ICD 10 Code for Left Knee Pain, ICD 10 Code for right Knee pain) and its coding guidelines along with examples.
We are all very familiar with the term knee pain. Anyone can get knee pain regardless of age. Knee is one of the biggest joint in body which joints thigh bone (femur) and lower leg joint (tibia). The knee cap is called patella. Tendons (flexible connective tissue) and ligaments (inelastic collagen tissue) help joining these bones and make the knee joint.
Symptoms and Causes:
Knee pain can be mild, moderate or severe. The reasons for pain can vary such as injury, overuse, infection and inflammation. Sometimes there may be swelling and redness depends on the cause. We need to visit doctor as per the severity and as per how long the pain lasts.
Mentioned below are few reasons for knee pain:
- Rheumatoid arthritis
- Septic arthritis
- Iliotibial band syndrome
- Patellar tendinitis
Tests and Diagnosis:
Physician will do extremity examination to check if there is any swelling, inflammation or injury. There may be need of radiological tests (X-ray, CT, MRI, ultrasound) or arthrocentesis (lab analysis of knee joint fluid) for further evaluation to check for infections or injury to tendon or ligament.
ICD 10 Code for Knee Pain and guidelines:
ICD 10 Code for knee pain is found in chapter 13 of ICD-10 CM manual – diseases of musculoskeletal system and connective tissue, code range M00 – M99
ICD 10 code for knee pain can be searched in ICD-10 CM manual index by 2 ways, search for pain- knee or pain-joint-knee. Both reach to the same code.
|ICD 10 Code for Knee Pain||ICD 10 Code for Knee Pain – Description|
|M25.561||ICD 10 code for Right knee pain|
|M25.562||ICD 10 code for Left knee pain|
|M25.569||ICD 10 code for Unspecified knee pain|
- Use codes M25.561 (ICD 10 code for Right knee pain) and M25.562 (ICD 10 code for Left knee pain) for bilateral knee pain as there is no particular code for bilateral pain.
- Review the entire medical record thoroughly especially physical examination to determine the correct anatomical site of pain. Do not code unspecified knee pain if there is any site specification mentioned in the record.
For example, patient comes in with unspecified knee pain as per HPI. Documented as left knee pain under physical exam-musculoskeletal-extremity section. Code left knee pain here.
- Knee pain is a symptom; hence follow ICD coding guideline of not coding signs and symptoms when there is a definitive diagnosis made.
Below are few examples on coding Knee pain.
ICD 10 code for Knee Pain Example1:
A 5 year old boy has been brought to emergency room after a fall. He was playing on monkey bar and fell down keeping knee on the floor. He hit his head on the bar while falling. He is crying and not allowing anyone to touch his right knee. Physical exam reveals scratches on hands. There is contusion on head. X-ray of right knee and head CT was done to check if any complications. Reports are reviewed by physician and interpreted as patellar fracture.
Diagnosis: Fracture right patella, Head contusion
S82.001A – Fracture right patella
S00.93XA – Contusion head
W09.8XXA – Fall from playground equipment
Note: There is no need to code ICD for knee pain here as this is due to definitive diagnosis Fracture.
ICD 10 code for Knee Pain Example2:
Mary is a 38 year old woman presenting to clinic for the first time with knee pain from past 6 months. Right pain is worse than left. She is unable to do her morning walk due to this pain. She feels difficulty in climbing stairs. She never visited any physician for knee pain. Her past, social and surgical history was reviewed which includes alcohol conception weekly once. Her height measured as 5 feet and weight as 145 pounds. Exam found normal gait and tenderness on both knees. She is neurologically intact on extremity neurological exam. Her X-ray results showed possible Hoffa’s syndrome.
Diagnosis: Chronic bilateral knee pain, possible Hoffa’s syndrome
M25.561 – ICD 10 code for Right knee pain
M25.562 – ICD 10 code for Left knee pain
G89.29 – Chronic pain
Note: Both ICD 10 code for right knee pain and ICD 10 code for left knee pain should be assigned for coding bilateral knee pain. Hoffa’s syndrome is not coded as it is mentioned as “possible”.