Knee pain is one of the most common complaints in clinical practice, but documenting it accurately can be a challenge. Vague diagnoses lead to claim denials, frustrated clinicians, and delayed patient care. For healthcare professionals, mastering the specific ICD-10 code for right knee pain—M25.561—is crucial for accurate billing and effective treatment planning. This guide will walk you through the essentials of using M25.561, with updates for 2025, and explain how AI-powered tools can streamline your documentation process.
M25.561 is the specific ICD-10-CM code for "Pain in right knee." This code is used to document pain that is localized to the right knee when a more definitive diagnosis has not yet been established. It is a billable code, meaning it can be used for reimbursement purposes.
Using a precise code like M25.561 is vital for several reasons:
Here are some realistic examples of when to use the ICD-10 code for right knee pain:
It's important to distinguish M25.561 from other related ICD-10 codes to ensure accuracy:
Creating detailed and accurate clinical documentation, including SOAP notes, is time-consuming. This is where AI-powered tools like S10.AI can make a significant difference.
Accurate and specific coding is essential for modern healthcare practices. For clinicians dealing with right knee pain, mastering the use of ICD-10 code M25.561 is a critical step toward reducing claim denials, improving documentation quality, and ensuring optimal patient care. By understanding when and how to use this code, and by leveraging the power of AI to streamline your workflow, you can enhance both your clinical and financial outcomes.
Ready to revolutionize your clinical documentation? Try CRUSH by S10.AI for accurate and effortless SOAP note automation.
FAQ's
1) When did the 2025 edition of ICD-10-CM M25.561 become effective?
When Did the 2025 Version of M25.561 Take Effect?
The latest update to the ICD-10-CM code M25.561—designating Pain in right knee—officially went into effect on October 1, 2024. This rollout aligns with the standard annual schedule set by the Centers for Medicare & Medicaid Services (CMS), ensuring that your documentation and billing practices reflect the most current requirements.
2) What is the code history for M25.561, including years of changes or updates?
Code History for M25.561
The ICD-10 code M25.561 for Pain in right knee has maintained remarkable consistency since its introduction. The code was officially added to the ICD-10-CM index in 2016 (taking effect October 1, 2015) and has seen no changes or updates in subsequent revisions. Each year from 2017 through 2025, M25.561 has retained its definition and status without modification, ensuring clarity and stability for both providers and payers.
3) What are the ICD-10-CM codes for pain in other joints, such as the left knee, hip, hand, ankle, and foot?
If you need to code for pain in joints beyond the right knee, there are several related ICD-10-CM options available depending on the exact location:
Left Knee: Use M25.562 for pain specifically in the left knee, and M25.569 if the affected knee is not specified.
Hip: For joint pain in the hip, select M25.551 (right hip), M25.552 (left hip), or M25.559 (unspecified hip).
Hand: Pain isolated to the hand joints falls under M25.541 (right hand), M25.542 (left hand), or M25.549 (unspecified hand). For general joint pain in the hand, M25.54 can be used.
Wrist: M25.539 is used for pain in the wrist when the side isn’t specified.
Ankle and Foot: For the ankle and joints of the foot, use M25.571 (right side), M25.572 (left side), or M25.579 (when the specific side is unknown).
Other Specified Joints: M25.59 is available for pain in other joints not covered above.
Choosing the most precise code will help ensure both clinical accuracy and proper documentation.
4) What are the ICD-10-CM codes adjacent to M25.561?
If you're navigating the coding maze around Pain in right knee (M25.561), knowing the neighboring options can make documentation a breeze. The ICD-10-CM system includes related codes that cover pain in nearby joints or in joints on the opposite side of the body:
For unspecified pain in the knee: M25.569 Pain in unspecified knee
For left knee pain: M25.562 Pain in left knee
For pain covering the ankle and joints of the foot, see:
M25.571 Pain in right ankle and joints of right foot
M25.572 Pain in left ankle and joints of left foot
M25.579 Pain in unspecified ankle and joints of unspecified foot
For hip pain, codes include:
M25.551 Pain in right hip
M25.552 Pain in left hip
M25.559 Pain in unspecified hip
Joint pain elsewhere? There are codes for the wrist (M25.539), hand joints (from M25.541 to M25.549), and for pain in other specified joints (M25.59).
Stiffness (not pain) gets its own codes: for example, M25.60 (unspecified joint) and M25.61 (shoulder).
So, when you need to specify joint pain in your records, these adjacent codes ensure you can pinpoint the discomfort—no matter which joint draws the short straw.
5) What are the parent and subcategory codes related to M25.561?
To code right knee pain accurately, it's important to recognize where M25.561 sits within the ICD-10 structure—and which codes you might encounter nearby. Think of the ICD-10 manual as a well-organized filing cabinet, each level helping you zero in on precision. Here’s the framework:
Parent Category:
M25 – Other joint disorder, not elsewhere classified
This is the broad group covering all sorts of joint problems that don’t fit neatly elsewhere.
Subcategory:
M25.5 – Pain in joint
Under M25, this narrows the focus specifically to joint pain, regardless of which joint.
Specific Code:
M25.561 – Pain in right knee
This is your go-to for isolated right knee pain when a more specific cause isn't documented.
Related/Adjacent Codes:
If you're coding for other similar clinical scenarios, these may come up as well:
M25.562 – Pain in left knee
M25.569 – Pain in unspecified knee
M25.55x – Pain in hip (right, left, unspecified)
M25.54x – Pain in joints of hand (right, left, unspecified)
M25.57x – Pain in ankle and joints of foot (right, left, unspecified)
Each of these is part of the same “pain in joint” family—so, if the right knee isn’t the culprit, you’ll likely find the appropriate code in this neighborhood.
Don’t forget: if external causes (like an injury on the tennis court or a tumble during your morning run) are at play, you should use an additional code to note the cause, per ICD-10’s guidelines.
6) Are there differences between the American and international versions of ICD-10 code M25.561?
It's important to note that while M25.561 specifically identifies Pain in right knee in the American ICD-10-CM system, coding conventions and numbering can vary in other countries. International adaptations—like the ICD-10-AM (Australia), ICD-10-CA (Canada), or other localizations—may use slightly different code structures or definitions. Always verify that the code you're using matches the requirements of your region or the payor to ensure accurate reimbursement and compliance with local regulations.
7) What are the approximate synonyms for pain in the right knee?
When you're coding for right knee pain using M25.561, you may encounter various clinical terms or chart notes that mean essentially the same thing. Some of the most common synonyms and related descriptors include:
Right knee joint pain
Chronic pain in the right knee
Long-standing right knee discomfort (greater than three months)
Pain localized to the right knee
Right-sided knee pain
Bilateral knee pain (if chart notes mention both knees, but verify laterality for coding specificity)
Persistent or ongoing right knee pain
While the wording may differ among providers or within documentation, all of these expressions can point you toward M25.561, provided the symptoms are isolated to the right knee and no more definitive diagnosis has been established.
8) How can M25.561 be converted to an ICD-9-CM code?
If you're looking to map the ICD-10 code M25.561 (Pain in right knee) to its equivalent in ICD-9-CM, the best match is 719.46, which represents Pain in joint, lower leg. Keep in mind that exact one-to-one conversions aren’t always possible due to differences in coding systems, but 719.46 is commonly used when transitioning from ICD-10 to ICD-9-CM for this specific knee pain diagnosis.
9) Within which ICD-10-CM code range does M25.561 fall?
The code M25.561 for Pain in right knee is grouped under the ICD-10-CM section dedicated to musculoskeletal conditions. Specifically, M25.561 falls within the M00–M99 range, which is reserved for Diseases of the musculoskeletal system and connective tissue. This range encompasses a variety of diagnoses related to joints, bones, muscles, and connective tissues—making it the primary chapter for almost all orthopedic and rheumatological coding, including knee pain.
Understanding this placement not only aids in accurate documentation but also reinforces the importance of selecting the correct code when navigating the complexities of insurance requirements and inter-disciplinary care.
10) What are the related codes for stiffness of joints?
When documenting stiffness of joints—distinct from pain—there are specific ICD-10 codes you'll want to be familiar with:
M25.6 – This is the umbrella code for Stiffness of joint, not elsewhere classified.
M25.60 – Use this for Stiffness of unspecified joint, when you haven't yet pinpointed which joint is affected.
M25.61 – If your patient presents with shoulder stiffness, Stiffness of shoulder, not elsewhere classified is the appropriate choice.
Selecting the right code based on the joint involved can help ensure diagnostic clarity and minimize payer confusion. Proper differentiation between pain and stiffness not only enhances your documentation, but also supports better clinical communication and reimbursement outcomes.
11) What Diagnostic Related Groups (MS-DRG) include ICD-10-CM code M25.561?
Understanding where M25.561 fits in the world of Diagnosis-Related Groups (DRGs) helps clinicians and billing teams anticipate reimbursement categories and streamline claims processing. This code—used for right knee pain—typically maps to DRGs associated with musculoskeletal signs and symptoms.
Specifically, cases coded with M25.561 are usually grouped under:
DRG 555: Signs and symptoms of the musculoskeletal system and connective tissue, with major complications or comorbidities (MCC)
DRG 556: Signs and symptoms of the musculoskeletal system and connective tissue, without major complications or comorbidities
This means that whether you are coding a straightforward pain presentation or a case involving more complex clinical considerations, M25.561 will direct claims to these musculoskeletal DRGs. This classification is important for both outpatient clinic visits and inpatient admissions, especially if the pain is part of the primary presenting problem.
Understanding this grouping helps you anticipate downstream impacts on reimbursement and ensures your documentation supports accurate DRG assignment.
12) What is the ICD-10-CM code range for other joint disorders?
The ICD-10-CM codes for other joint disorders are found in the M20–M25 range. This category covers a variety of joint conditions but excludes disorders involving the spine, which are classified separately under M40–M54. Properly distinguishing joint pain locations using the correct code range is essential for clear documentation and accurate claim submission.
What is the difference between ICD-10 code M25.561 and M17.11 for right knee pain?
The key difference lies in the specificity of the diagnosis. M25.561 is used for a general complaint of 'pain in the right knee' when a definitive cause has not yet been established. It's the appropriate code for an initial consultation or when the patient's symptoms are still being evaluated. On the other hand, M17.11 is used for a confirmed diagnosis of 'unilateral primary osteoarthritis of the right knee.' This code indicates that the underlying cause of the knee pain has been identified as osteoarthritis. Using the correct code is crucial for accurate medical records, effective treatment planning, and successful insurance reimbursement.
When should I use the unspecified knee pain ICD-10 code M25.569?
The ICD-10 code M25.569 represents 'pain in unspecified knee.' This code should be used sparingly and only in situations where the laterality (right or left) of the knee pain is not documented or cannot be determined. However, relying on unspecified codes can lead to claim denials or delays, as payers increasingly require more specific diagnostic information. It is always best practice to specify the side of the knee pain whenever possible, using M25.561 for the right knee and M25.562 for the left knee.
Can I use M25.561 for both acute and chronic right knee pain?
Yes, M25.561 can be used to document both acute and chronic pain in the right knee, as long as a more specific underlying diagnosis has not been established. The code itself does not specify the duration of the pain. To provide a complete clinical picture, it's important to document the onset and duration of the pain in the patient's medical record. For example, you might note: 'Acute right knee pain: Patient presents with a 3-day history of sharp pain in the right knee after a fall.' or 'Chronic right knee pain: Patient reports a dull, aching pain in the right knee for the past 6 months, with no history of injury.
Hey, we're s10.ai. We're determined to make healthcare professionals more efficient. Take our Practice Efficiency Assessment to see how much time your practice could save. Our only question is, will it be your practice?
We help practices save hours every week with smart automation and medical reference tools.
+200 Specialists
Employees4 Countries
Operating across the US, UK, Canada and AustraliaWe work with leading healthcare organizations and global enterprises.