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M25.569
ICD-10-CM
Knee Joint Pain

Find information on knee joint pain diagnosis, including relevant healthcare, clinical documentation, and medical coding terms. Learn about common causes of knee pain, such as osteoarthritis, meniscus tears, ligament injuries, and patellofemoral pain syndrome. Explore diagnostic tests like physical exams, X-rays, MRI scans, and arthroscopy. Understand medical coding for knee pain diagnoses, including ICD-10 codes and CPT codes for procedures. This resource provides valuable information for healthcare professionals, clinicians, and medical coders seeking accurate and efficient documentation and coding of knee joint pain.

Also known as

Knee Pain
Pain in Knee Joint

Diagnosis Snapshot

Key Facts
  • Definition : Discomfort or pain localized in or around the knee joint.
  • Clinical Signs : Swelling, stiffness, limited range of motion, tenderness, clicking or popping sounds.
  • Common Settings : Arthritis, injury (ACL tear, meniscus tear), overuse, bursitis.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M25.569 Coding
M25.5

Pain in knee joint

Pain localized to the knee joint.

M17

Gonarthrosis

Degenerative joint disease of the knee.

S83

Dislocation and sprain of knee

Includes injuries to ligaments and menisci.

M79.6

Pain in limb

Pain in limb, including knee pain if not otherwise specified.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the knee pain due to trauma/injury?

  • Yes

    Is there a fracture?

  • No

    Is there inflammation?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Knee Joint Pain
Osteoarthritis Knee
Patellofemoral Pain Syndrome

Documentation Best Practices

Documentation Checklist
  • Knee pain location, laterality (R/L/bilateral)
  • Pain characteristics: onset, type, radiation
  • Physical exam: ROM, tenderness, effusion, instability
  • Imaging results if performed (X-ray, MRI, etc.)
  • Diagnosis codes (ICD-10): specify primary diagnosis

Coding and Audit Risks

Common Risks
  • Unspecified Pain

    Coding knee pain as unspecified (M25.561) without documenting specific location or laterality risks downcoding and lost revenue.

  • Osteoarthritis vs. Pain

    Confusing osteoarthritis (M17) with knee pain if the documentation does not clearly establish cause-and-effect impacts accurate coding and reimbursement.

  • Trauma Coding

    Failing to code related injuries or fractures alongside knee pain due to trauma (S89) leads to incomplete documentation and potential compliance issues.

Mitigation Tips

Best Practices
  • Document laterality, specific location, onset, and character of knee pain.
  • Code to the highest specificity using ICD-10 and CPT codes. Avoid unspecified codes.
  • Query physician for clarity if documentation lacks detail for accurate coding.
  • Use standardized terminology for knee pain diagnoses for consistent CDI.
  • Ensure compliance with medical necessity guidelines for diagnostic testing and procedures.

Clinical Decision Support

Checklist
  • Verify laterality: left or right knee documented
  • Confirm pain onset, duration, and character
  • Assess ROM, palpation tenderness, and stability
  • Check for prior imaging, injections, or surgeries
  • Document ICD-10 code and justify medical necessity

Reimbursement and Quality Metrics

Impact Summary
  • Knee Joint Pain: Coding accuracy impacts reimbursement for M79.6X, M25.5X, and related diagnoses.
  • Proper documentation of knee pain etiology (OA, injury, etc.) maximizes correct code assignment & payment.
  • Inaccurate knee pain coding negatively affects hospital quality reporting metrics & value-based care.
  • Precise knee pain diagnosis coding ensures appropriate resource allocation and patient care quality.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code laterality: left/right knee
  • Document pain onset, location, type
  • Specify if acute, chronic, or post-op
  • Include imaging/procedure findings
  • Consider associated diagnoses: arthritis, injury

Documentation Templates

Patient presents with knee pain, experiencing symptoms consistent with knee joint pain.  Onset of pain was (gradual/acute) and began (duration) ago.  The patient describes the pain as (sharp, dull, aching, throbbing, etc.) and localized to the (anterior, posterior, medial, lateral) aspect of the knee.  Pain is (constant/intermittent) and aggravated by (activities such as walking, stairs, running, prolonged standing, etc.).  Alleviating factors include (rest, ice, elevation, medication).  Patient denies (or reports) any locking, popping, clicking, giving way, or instability.  The patient reports (or denies) previous knee injuries, surgeries, or arthritis.  Physical examination reveals (tenderness to palpation, swelling, erythema, warmth, range of motion limitations, crepitus, joint effusion, ligamentous instability).  McMurrays and Lachman tests were (positive/negative).  Differential diagnosis includes osteoarthritis, meniscus tear, ligament sprain, bursitis, patellofemoral pain syndrome, tendinitis, and referred pain.  Assessment: Knee pain, likely due to (presumptive diagnosis based on history and physical exam). Plan:  Conservative management with (RICE - rest, ice, compression, elevation), NSAIDs for pain relief, physical therapy referral for strengthening and range of motion exercises.  Consider diagnostic imaging (X-ray, MRI) if symptoms persist or worsen.  Follow-up scheduled in (duration).  Patient education provided on activity modification and home exercises.  Medical coding considerations include ICD-10 code for knee pain (e.g., M25.56) and CPT codes for evaluation and management (e.g., 99203-99205 for new patients, 99212-99215 for established patients), as well as any procedures performed.  Further diagnostic testing or specialist referral may necessitate additional codes.
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