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ICD-10 Guide
ICD-10 CodesM02.86

M02.86

Billable

Other reactive arthropathies, knee

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 M02.86 is a billable code used to indicate a diagnosis of other reactive arthropathies, knee.

Key Diagnostic Point:

Reactive arthropathies are inflammatory joint conditions that arise secondary to infections or other inflammatory processes elsewhere in the body. The knee joint, a complex hinge joint formed by the femur, tibia, and patella, is particularly susceptible to these conditions due to its weight-bearing function and range of motion. Clinically, patients may present with joint swelling, pain, and stiffness, often following a systemic infection or inflammatory trigger. The pathophysiology involves immune-mediated responses that lead to synovial inflammation and joint effusion. Patients may experience limited range of motion, particularly in flexion and extension, impacting daily activities. Diagnosis typically involves clinical evaluation, imaging studies, and laboratory tests to rule out other causes of arthritis. Treatment may include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and physical therapy to restore function and alleviate symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes leading to reactive arthropathies
  • Need for differential diagnosis to rule out other arthritic conditions
  • Potential for systemic involvement requiring comprehensive documentation
  • Variability in clinical presentation and severity among patients

Audit Risk Factors

  • Inadequate documentation of the underlying cause of the reactive arthropathy
  • Failure to document the severity and functional limitations of the condition
  • Lack of supporting imaging or laboratory results
  • Misclassification of the condition as a primary arthropathy

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Orthopedic documentation should include imaging studies (X-rays, MRIs) to assess joint integrity and functional assessments to evaluate range of motion and strength.

Common Clinical Scenarios

Patients may present with knee pain post-infection or following a systemic inflammatory response, requiring surgical intervention if conservative measures fail.

Billing Considerations

Joint-specific considerations include assessing for joint effusion, ligament stability, and potential need for arthroscopy.

Rheumatology

Documentation Requirements

Rheumatologic documentation should include inflammatory markers (CRP, ESR) and assessments of disease activity to monitor progression.

Common Clinical Scenarios

Patients may have a history of autoimmune conditions or recent infections, necessitating a comprehensive evaluation of systemic involvement.

Billing Considerations

Consideration of comorbidities and the potential for chronicity in reactive arthropathies is crucial.

Physical Medicine

Documentation Requirements

Functional assessments should document mobility limitations, pain levels, and the need for assistive devices.

Common Clinical Scenarios

Rehabilitation scenarios may involve post-infection recovery or post-surgical rehabilitation following joint interventions.

Billing Considerations

Focus on restoring functional mobility and independence in daily activities.

Coding Guidelines

Inclusion Criteria

Use M02.86 When
  • Follow official coding guidelines for laterality (right, left, bilateral), severity (acute vs
  • chronic), and encounter type (initial vs
  • follow
  • Ensure comprehensive documentation supports the diagnosis and treatment plan

Exclusion Criteria

Do NOT use M02.86 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used for joint effusion management in reactive arthropathies.

Documentation Requirements

Document the joint involved, amount of fluid removed, and any therapeutic agents injected.

Specialty Considerations

Orthopedic and rheumatologic considerations for joint health and recovery.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has increased specificity in coding musculoskeletal conditions, allowing for better tracking of reactive arthropathies and their management.

ICD-9 vs ICD-10

The transition to ICD-10 has increased specificity in coding musculoskeletal conditions, allowing for better tracking of reactive arthropathies and their management.

Reimbursement & Billing Impact

The transition to ICD-10 has increased specificity in coding musculoskeletal conditions, allowing for better tracking of reactive arthropathies and their management.

Resources

Clinical References

  • •
    American College of Rheumatology Guidelines

Coding & Billing References

  • •
    American College of Rheumatology Guidelines

Frequently Asked Questions

What are the common causes of reactive arthropathies?

Common causes include infections (bacterial, viral), autoimmune conditions, and post-infectious inflammatory responses. It is crucial to identify the underlying trigger to guide treatment.