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ICD-10 Guide
ICD-10 CodesM25.561

M25.561

Billable

Pain in right knee

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M25.561 is a billable code used to indicate a diagnosis of pain in right knee.

Key Diagnostic Point:

Pain in the right knee can arise from various internal derangements, including meniscal tears, ligament injuries, and degenerative changes such as osteoarthritis. The knee joint is complex, comprising bones, cartilage, ligaments, and tendons, making it susceptible to injuries and conditions that can lead to pain. Meniscal tears often occur due to twisting injuries or degeneration over time, leading to symptoms such as swelling, stiffness, and locking of the knee. Ligament injuries, particularly to the anterior cruciate ligament (ACL) or medial collateral ligament (MCL), can result from acute trauma during sports or falls, presenting with pain, instability, and swelling. Arthroscopic procedures are commonly employed for diagnosis and treatment of these conditions, allowing for minimally invasive intervention to repair or remove damaged tissue. Accurate coding for knee pain requires a thorough understanding of the underlying causes, as well as the specific documentation of the patient's clinical presentation and any imaging or surgical interventions performed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various causes of knee pain (e.g., meniscal tears vs. ligament injuries)
  • Need for detailed documentation of the patient's history and physical examination findings
  • Variability in treatment approaches (e.g., conservative management vs. surgical intervention)
  • Potential for co-existing conditions (e.g., osteoarthritis, bursitis) that may complicate coding

Audit Risk Factors

  • Insufficient documentation of the specific cause of knee pain
  • Failure to include relevant imaging studies or surgical notes
  • Inconsistent coding of co-existing conditions
  • Lack of clarity in the patient's treatment plan

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on physical examination findings, imaging results, and treatment plans are essential.

Common Clinical Scenarios

Patients presenting with acute knee injuries, chronic knee pain, or post-operative follow-ups.

Billing Considerations

Orthopedic documentation must clearly outline the specific diagnosis and any surgical interventions performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and treatment goals are necessary.

Common Clinical Scenarios

Patients undergoing rehabilitation for knee injuries or post-surgical recovery.

Billing Considerations

Focus on documenting the patient's progress and response to therapy.

Coding Guidelines

Inclusion Criteria

Use M25.561 When
  • According to ICD
  • 10 guidelines, M25
  • 561 should be used when the primary complaint is pain localized to the right knee
  • Coders must ensure that the documentation supports the diagnosis and that any relevant co
  • existing conditions are also coded appropriately

Exclusion Criteria

Do NOT use M25.561 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

29881CPT Code

Arthroscopy, knee, diagnostic, with or without synovial biopsy

Clinical Scenario

Used when a patient with knee pain undergoes arthroscopic evaluation.

Documentation Requirements

Document the indication for the procedure and findings from the arthroscopy.

Specialty Considerations

Orthopedic specialists should ensure that the procedure aligns with the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding knee pain, enabling better tracking of conditions and outcomes. M25.561 provides a clear designation for pain in the right knee, facilitating improved patient management and billing accuracy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding knee pain, enabling better tracking of conditions and outcomes. M25.561 provides a clear designation for pain in the right knee, facilitating improved patient management and billing accuracy.

Reimbursement & Billing Impact

billing accuracy.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What documentation is needed to support the use of M25.561?

Documentation should include a detailed history of the patient's knee pain, physical examination findings, any imaging studies performed, and the treatment plan. Specific details about the pain's onset, duration, and any associated symptoms are also crucial.