Wiki Osteoarthritis and pain.

Community Wiki

This is a community-maintained wiki post containing the most important information from this thread. You may edit the Wiki once you have been on AAPC for 30 days and have made 5 posts. Learn More
Code: M17.12

Code Name: ICD-10 Code for Unilateral primary osteoarthritis, left knee

Block: Unilateral primary osteoarthritis, left knee

Details: Osteoarthritis (M15-M19)

Excludes 2: osteoarthritis of spine (M47.-)

Arthropathies (M00-M25)

Includes: Disorders affecting predominantly peripheral (limb) joints"

Guidelines: Diseases of the musculoskeletal system and connective tissue (M00-M99)

Note: Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition

Excludes 2: arthropathic psoriasis (L40.5-)
certain conditions originating in the perinatal period (P04-P96)
certain infectious and parasitic diseases (A00-B99)
compartment syndrome (traumatic) (T79.A-)
complications of pregnancy, childbirth and the puerperium (O00-O9A)
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
endocrine, nutritional and metabolic diseases (E00-E88)
injury, poisoning and certain other consequences of external causes (S00-T88)
neoplasms (C00-D49)
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

For more details on M17.12 , ICD-10 Code for Unilateral primary osteoarthritis, left knee , visit:
Allen, TX
Best answers

For ICD-10: If a medical record states patient has "unspecified osteoarthritis" and in a different section "patient has knee pain". (both having support, but not linked to each outer). Would you code M19.90 and M25.569? or just the M19.90?



Jacksonville Florida Chapter
Best answers
Hey Ashley...

One thing you never want to use is an unspecified code. It irritates me that they're in ICD-10 because the "unspecified" codes won't get you paid. The way insurance companies see it (at least in the world of orthopedics), the provider did the exam so they must know where the issue is.

You need to ask the provider for more information because in order to code correctly, you need to know which knee was examined and if osteoarthritis was found. Providers need to understand that "unspecified" won't work with ICD-10. Once you get that information, I would code M25.561 for right knee pain or M25.562 for left knee pain or M17.11 for right knee osteoarthritis or M17.12 for left knee osteoarthritis or M17.0 for both knees assuming that was a finding.


Best answers
Knee Pain and Osteoarthritis

Ashley: What John said/replied is generally correct. There is no such thing as "Unspecified" Osteoarthritis. "Osteoarthritis" of the Knee, M17. _/_, comes in only three forms according to ICD-10: Primary, Post-traumatic, and Secondary, and is either "bilateral" or "unilateral." It would "seem" that your physician was trying to say that the patient had knee pain as a result of osteoarthritis, but said/documented it very badly, and he should do better and make it clear.

As for using the code for knee pain, M25.56 _, this should be used only if there is no clear explanation/cause for the patient's knee pain. "Pain" is a symptom, not a disease. This code will get the patient down the hall to the X-ray Department for X-rays of the knee(s), but should be removed from the diagnosis list and replaced by the "diagnosis" code once it is known, i.e. osteoarthritis of the knee in this case. If the patient's knee pain is adequately explained by the arthritis, then it should not be listed in the diagnosis list at all. In general, if a doctor says his patient has "Osteoarthritis" of any joint, then they are referring to "Primary Osteoarthritis" of that joint. Post-traumatic and Secondary Osteoarthritis as diagnoses have to be supported in the documentation by specific information that would justify using them. As for your particular case, I would only list the code for Osteoarthritis of the Knee (M17.11, right, or M17.12, left) as suggested by John.

I would refer you to the website where I have several "Blogs" discussing coding for Pain, Arthralgia vs Arthritis, Arthritis, and Knee Pain. These, and some of the other Blogs, may be useful to you.

Respectfully submitted, Alan Pechacek, M.D. (