Identify Bilateral and Unilateral OA Knee Codes
Question: A 54-year-old patient presented for a follow-up appointment for their knee pain due to osteoarthritis (OA). The patient stated that after their third injection of hyaluronic acid, the hyaluronic acid helped the symptoms until recently. Now, the patient feels like their knees are “creaky.” They attested to having difficulty sleeping secondary to right knee pain, and they use a pillow to adjust accordingly to sleep. The patient also has difficulty bending their knees (especially the right knee), and they use a stationary bicycle three times a week for exercise. The orthopedist assigned M17.11 and M17.12 for the patient’s condition, but I think we should use M17.9 instead. Which diagnosis codes are correct? New York Subscriber Answer: From the information you’ve provided, it sounds like the patient is suffering from bilateral knee pain due to OA. If that is correct, then you’ll assign M17.0 (Bilateral primary osteoarthritis of knee) to report the patient’s condition. The provider is incorrect to use M17.11 (Unilateral primary osteoarthritis, right knee) and M17.12 (… left knee) for the condition because these are unilateral (one side) codes. Only one of these codes should be used if the orthopedist identifies primary OA in one of the knees; since the patient is experiencing OA in both knees and the ICD-10-CM code book contains a code specifying the condition, you will use the bilateral primary OA knee code. The code book also contains secondary OA codes. The difference between primary and secondary OA is how the joint disease develops. Primary OA is the most common form of the joint disease and occurs naturally over time. Secondary OA typically develops following an abnormality in the joint, such as an injury or trauma, inflammatory arthritis, or congenital joint disorder. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
