Facebook tracking pixel
M25.461
ICD-10-CM
Right Knee Swelling

Find information on right knee swelling diagnosis, including clinical documentation, medical coding (ICD-10, SNOMED CT), differential diagnosis, and treatment options. Explore causes of right knee effusion, knee pain, and swelling symptoms. Learn about relevant medical examinations, imaging studies (MRI, X-ray), and laboratory tests for accurate diagnosis and appropriate management of right knee swelling. This resource offers valuable insights for healthcare professionals, clinicians, and medical coders seeking information on right knee swelling.

Also known as

Right Knee Effusion
Right Knee Fluid Accumulation

Diagnosis Snapshot

Key Facts
  • Definition : Fluid buildup within the right knee joint causing noticeable enlargement.
  • Clinical Signs : Pain, stiffness, limited range of motion, warmth, redness, visible swelling.
  • Common Settings : Sports injuries, arthritis, infections, overuse, trauma.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M25.461 Coding
M25.461

Pain in right knee

Swelling is often associated with knee pain.

M17-M19

Gonarthrosis

Osteoarthritis of the knee can cause swelling.

S83.601A

Sprain of right knee

Knee sprains often result in swelling.

M79.861

Other specified disorders of right knee

This includes various conditions causing knee swelling.

Code Comparison

Related Codes Comparison

When to use each related code

Description
Right Knee Swelling
Right Knee Effusion
Right Knee Pain

Documentation Best Practices

Documentation Checklist
  • Right knee swelling: Onset, duration, character
  • Location and laterality: Specify right knee
  • Associated symptoms: Pain, stiffness, limited ROM
  • Physical exam findings: Palpation, effusion, erythema
  • Differential diagnoses considered and ruled out

Coding and Audit Risks

Common Risks
  • Unspecified Swelling

    Coding right knee swelling with unspecified codes (e.g., 719.46) when more specific diagnoses are documented, impacting reimbursement and data accuracy. Relevant to ICD-10 coding, medical coding audits, and CDI.

  • Trauma vs. Non-Trauma

    Failing to distinguish between traumatic (e.g., S83.1xxA) and non-traumatic (e.g., M25.561) causes of right knee swelling. Impacts accurate reporting for quality metrics, claims, and healthcare compliance audits.

  • Laterality and Specificity

    Incorrectly coding laterality (right vs. left) or using non-specific codes for knee swelling when documentation supports a more precise diagnosis. Impacts claims processing, medical necessity reviews, and CDI efforts.

Mitigation Tips

Best Practices
  • Document laterality, onset, characteristics, and associated symptoms for accurate ICD-10 coding (M25.46).
  • Ensure specific exam details like ROM, tenderness, effusion to support M25.46 and justify medical necessity.
  • Query physician for clarity if documentation lacks detail to avoid denials and ensure appropriate reimbursement.
  • Use standardized terminology for knee swelling (e.g., effusion, edema) for consistent CDI and data analysis.
  • Review clinical documentation against payer guidelines for knee pain/swelling to ensure compliance and accurate billing.

Clinical Decision Support

Checklist
  • Verify right knee location documented
  • Confirm laterality in imaging matches documentation
  • Assess for trauma history document mechanism
  • Evaluate and document range of motion limitations
  • Palpate for effusiontenderness warmth crepitus

Reimbursement and Quality Metrics

Impact Summary
  • Right Knee Swelling: Coding accuracy impacts reimbursement for effusion, pain management, arthrocentesis. Optimize ICD-10 (M25.46) for maximum payment.
  • Hospital reporting: Accurate Right Knee Swelling diagnosis codes (M25.46) improve quality metrics for osteoarthritis, joint pain, and trauma.
  • Medical billing: Clear documentation of Right Knee Swelling etiology (e.g., injury, inflammation) ensures appropriate CPT codes for optimal reimbursement.
  • Quality metrics: Tracking Right Knee Swelling diagnoses (M25.46) helps monitor patient outcomes and improve treatment protocols for joint health.

Streamline Your Medical Coding

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

Quick Tips

Practical Coding Tips
  • Code knee effusion, 719.01
  • Specify laterality: right knee
  • Document swelling cause
  • Rule out trauma, M79.661
  • Consider prepatellar bursitis

Documentation Templates

Patient presents with complaints of right knee swelling.  Onset of swelling was (duration) and is characterized as (character of swelling:  e.g., gradual, sudden, intermittent, constant).  Patient reports (presence or absence of pain) described as (character of pain: e.g., sharp, dull, aching, throbbing) and located (location of pain: e.g., medial, lateral, anterior, posterior, diffuse).  Pain is (severity of pain: e.g., mild, moderate, severe) and aggravated by (aggravating factors: e.g., weight-bearing, activity, rest) and relieved by (relieving factors: e.g., rest, ice, elevation, medication).  Associated symptoms include (associated symptoms: e.g., stiffness, limited range of motion, warmth, redness, locking, clicking, popping, instability).  Patient denies (denied symptoms: e.g., fever, chills, trauma, recent infection).  Physical examination reveals (objective findings: e.g., edema, erythema, tenderness to palpation, effusion, crepitus, decreased range of motion, ligamentous instability).  Differential diagnosis includes osteoarthritis, rheumatoid arthritis, meniscus tear, ligament sprain, bursitis, tendinitis, Baker's cyst, infection, and deep vein thrombosis.  Plan includes (diagnostic tests: e.g., right knee x-ray, MRI, ultrasound, aspiration) and (treatment plan: e.g., RICE therapy, NSAIDs, physical therapy, referral to orthopedics, aspiration and injection).  Patient education provided regarding right knee pain management, activity modification, and follow-up care.  Return to clinic scheduled in (duration).  ICD-10 code: (appropriate ICD-10 code, e.g., M25.561 - Swelling of right knee).
Right Knee Swelling - AI-Powered ICD-10 Documentation