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Pain in Right Knee ICD 10: Code Set for Specific Injuries

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John H
Health Enthusiastt
18 min read

Pain in Right Knee ICD 10: Code Set for Specific Injuries

When it comes to diagnosing and treating musculoskeletal conditions, accurate medical coding is essential. For healthcare providers, assigning the correct ICD-10 code ensures proper documentation, billing, and patient care. One common complaint seen in clinical practice is pain in the right knee. This article provides a comprehensive guide to the ICD-10 codes associated with right knee pain, focusing on specific injuries and conditions. Whether you're a medical coder, physician, physical therapist, or patient wanting to understand your diagnosis, this guide will help clarify the appropriate ICD-10 coding for pain in the right knee.

Understanding ICD-10 Coding for Knee Pain

The International Classification of Diseases, 10th Revision (ICD-10), is a standardized system used by healthcare professionals to classify and code all diagnoses, symptoms, and procedures. Accurate coding ensures consistency across healthcare systems, aids in epidemiological research, and supports proper insurance reimbursement.

Pain in the right knee may stem from various causes—trauma, overuse, degenerative conditions, or systemic diseases. The ICD-10 system allows for specific coding based on the location, laterality (right or left), and underlying cause of the pain. This specificity is crucial for effective treatment planning and accurate medical records.

General ICD-10 Code for Knee Pain

The most commonly used general code for knee pain is M25.561. This code stands for 'Pain in right knee.' It belongs to the larger category of 'Other joint disorders, not elsewhere classified' under the musculoskeletal chapter (M00–M99).

This code is appropriate when knee pain is the primary symptom and no definitive diagnosis has been established. However, it should not be used if a more specific diagnosis is known, such as osteoarthritis, ligament tear, or meniscal injury.

Common Causes of Right Knee Pain and Their ICD-10 Codes

While M25.561 serves as a general code for knee pain, many specific conditions require more precise coding. Below are the most frequent causes of right knee pain along with their corresponding ICD-10 codes.

1. Osteoarthritis of the Right Knee

Osteoarthritis (OA) is a degenerative joint disease commonly affecting weight-bearing joints such as the knee. It causes pain, stiffness, and reduced mobility.

If the osteoarthritis is secondary to another condition (e.g., previous injury), the code M17.21 (Secondary osteoarthritis, right knee) should be used instead.

2. Meniscal Tears

Meniscal tears are common knee injuries, especially among athletes or older adults with degenerative menisci. Tears can occur in the medial or lateral meniscus.

The seventh character indicates the encounter type: A (initial), D (routine follow-up), or S (after-effects). For example, S83.211A is used for a patient’s first visit for a medial meniscus tear in the right knee.

3. Ligament Sprains and Tears

Knee ligament injuries, particularly to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), are major sources of knee pain.

These codes reflect the specific ligament affected and the side (right = 1). The encounter type is critical for accurate billing and tracking.

4. Patellofemoral Pain Syndrome (PFPS)

Also known as 'runner’s knee,' PFPS is characterized by pain around or behind the kneecap. It’s common in individuals who engage in activities involving repeated knee bending.

While there isn't a standalone code for PFPS, M22.2X1 is often used when patellar malalignment or stress is diagnosed. The 'X' is a placeholder and the full code becomes M22.211 for the right knee.

5. Bursitis of the Right Knee

Bursitis involves inflammation of the bursae—fluid-filled sacs that cushion the knee joint. Prepatellar bursitis ('housemaid’s knee') and pes anserine bursitis are common types.

These codes fall under 'Other bursopathies' and specify the location and laterality.

6. Tendinitis and Tendinopathy

Patellar tendinitis, or 'jumper’s knee,' results from overuse and causes pain below the kneecap. Quadriceps tendinitis affects the tendon above the patella.

These are categorized under 'enthesopathies' and require accurate laterality coding.

7. Gouty Arthritis in the Right Knee

Gout is a form of inflammatory arthritis caused by uric acid crystal deposition in joints. The knee can be affected, leading to sudden, severe pain and swelling.

Other variations include M1A.1611 (tophus present) or M1A.1612 (without tophus, with gouty arthropathy). The code M10.161 is used for secondary gout affecting the right knee.

8. Rheumatoid Arthritis (RA)

Rheumatoid arthritis is an autoimmune condition that commonly affects multiple joints, including the knees. It causes symmetrical joint pain, swelling, and stiffness.

These codes depend on serological test results and disease specifics.

9. Post-Traumatic Arthritis

This form of arthritis develops after an injury to the knee, such as a fracture or ligament tear.

It’s important to distinguish this from primary osteoarthritis, especially when there’s a documented history of trauma.

10. Fractures of the Right Knee

Fractures involving the patella, femoral condyle, or tibial plateau can cause significant pain and require surgical intervention.

The 'A' suffix indicates the initial encounter for a closed fracture. Open fractures and subsequent care use different 7th characters.

When to Use M25.561 vs. Specific Diagnosis Codes

Choosing between a nonspecific symptom code like M25.561 and a more specific diagnosis code depends on the clinical context.

Use M25.561 when:

Use a specific code when:

Using specific codes improves data accuracy, supports treatment tracking, and reduces claim denials.

Importance of Laterality in ICD-10 Coding

Laterality—indicating whether the condition affects the right or left side—is a critical component of ICD-10 coding. For the knee, the sixth character specifies the joint, and the seventh indicates laterality.

For example:

Similarly, S83.211 refers to a medial meniscus tear in the right knee, while S83.212 is for the left.

Failure to specify laterality can result in coding errors and claim rejections. Always confirm the affected side during patient assessment.

Documentation Tips for Accurate ICD-10 Coding

Proper documentation is the foundation of accurate coding. Here are key tips for clinicians and coders: