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M25.569
ICD-10-CM
Knee Pain

Find information on knee pain diagnosis, including clinical documentation, medical coding, and healthcare resources. This guide covers common knee pain symptoms, differential diagnosis considerations, ICD-10 codes for knee pain (e.g., pain in knee joint, patellofemoral pain syndrome), and relevant medical terminology for accurate documentation. Learn about evaluating knee pain, diagnostic tests, and treatment options. Explore resources for healthcare professionals related to knee pain management and coding best practices.

Also known as

Knee Joint Pain
Patellar Pain
Knee Discomfort
+1 more

Diagnosis Snapshot

Key Facts
  • Definition : Discomfort or pain in or around the knee joint.
  • Clinical Signs : Swelling, stiffness, limited range of motion, clicking or popping, tenderness to touch.
  • 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

Pain localized to the knee joint.

S70-S79

Injuries to the knee and lower leg

Includes fractures, sprains, and other injuries around the knee.

M15-M19

Arthrosis

Degenerative joint diseases, including knee osteoarthritis, can cause pain.

M00-M99

Diseases of the musculoskeletal system and connective tissue

Broader category encompassing various conditions causing knee pain.

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 pain, unspecified
Patellofemoral pain syndrome
Knee osteoarthritis

Documentation Best Practices

Documentation Checklist
  • Knee pain location (medial, lateral, anterior, posterior)
  • Pain characteristics (sharp, dull, aching, burning, throbbing)
  • Onset and duration of knee pain (acute, chronic, intermittent)
  • Aggravating and alleviating factors (activities, rest, medications)
  • Physical exam findings (effusion, tenderness, range of motion)

Coding and Audit Risks

Common Risks
  • Unspecified Knee Pain

    Coding knee pain with unspecified codes (e.g., M25.56) when more specific diagnoses are documented leads to inaccurate severity reflection and reimbursement.

  • Lateral vs. Medial Pain

    Incorrectly coding lateral (outer) or medial (inner) knee pain can impact treatment plans and lead to denials for laterality-specific procedures.

  • Trauma vs. Chronic Pain

    Failing to distinguish between traumatic knee pain (e.g., S72.1XXA) and chronic conditions (e.g., M25.561) impacts data accuracy and case mix index.

Mitigation Tips

Best Practices
  • Document laterality: left, right, or bilateral knee pain.
  • Specify pain onset: acute, chronic, or post-op.
  • Code precise location: patella, meniscus, or joint.
  • Link pain to causative factors: injury, arthritis, or overuse.
  • Detail physical exam: ROM, swelling, tenderness for accurate ICD-10 coding.

Clinical Decision Support

Checklist
  • Verify laterality: left or right knee documented
  • Confirm pain onset, duration, and character
  • Assess for mechanical symptoms lockingcatchingclicking
  • Evaluate ROM, palpation tenderness, and stability
  • Document ICD-10 code M25571 M25572 for knee pain

Reimbursement and Quality Metrics

Impact Summary
  • Knee Pain reimbursement hinges on accurate ICD-10 coding (M25.5-, 719.46) impacting claim denials.
  • Coding quality directly affects hospital reporting for Knee Pain severity and resource allocation.
  • Proper documentation of Knee Pain symptoms is crucial for appropriate E/M coding and maximized reimbursement.
  • Accurate Knee Pain diagnosis coding improves data integrity for population health management and value-based care.

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 specifics: sharp, dull, aching
  • Specify onset: acute, chronic, traumatic
  • Consider associated symptoms: swelling, stiffness
  • Use ICD-10 codes for knee pain diagnoses

Documentation Templates

Patient presents with knee pain, the chief complaint being [character of pain: e.g., sharp, dull, aching, throbbing] localized to the [location of pain: e.g., medial, lateral, anterior, posterior] aspect of the [right or left] knee.  Onset of pain was [onset: e.g., gradual, sudden] [timeframe: e.g., two weeks ago, following a fall yesterday].  Pain is aggravated by [aggravating factors: e.g., weight-bearing, stairs, prolonged standing] and relieved by [relieving factors: e.g., rest, ice, elevation].  Patient denies any locking, clicking, or giving way.  Associated symptoms include [associated symptoms: e.g., stiffness, swelling, warmth, redness, limited range of motion].  Patient's past medical history includes [past medical history: e.g., osteoarthritis, rheumatoid arthritis, previous knee injury].  Medications include [medications: e.g., ibuprofen, acetaminophen].  Allergies include [allergies: e.g., none, penicillin].  Physical examination reveals [physical exam findings: e.g., tenderness to palpation over the medial joint line, mild effusion, full range of motion with pain at end range of flexion].  Differential diagnosis includes [differential diagnosis: e.g., osteoarthritis, meniscus tear, ligament sprain, patellofemoral pain syndrome].  Assessment: Knee pain, likely due to [likely diagnosis: e.g., osteoarthritis]. Plan:  [Plan: e.g., Recommend conservative management including rest, ice, compression, elevation.  Prescribed ibuprofen 800mg every 8 hours as needed for pain.  Referred to physical therapy.  Follow-up in 2 weeks to reassess.  If symptoms worsen, consider MRI of the knee].
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