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ICD-10 Guide
ICD-10 CodesM23.004

M23.004

Billable

Cystic meniscus, unspecified medial meniscus, left knee

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

Code Description

ICD-10 M23.004 is a billable code used to indicate a diagnosis of cystic meniscus, unspecified medial meniscus, left knee.

Key Diagnostic Point:

Cystic meniscus refers to a condition where a cyst forms within the meniscus of the knee, specifically affecting the medial meniscus on the left side. This condition is often associated with internal derangements of the knee joint, which can include meniscal tears, ligament injuries, and degenerative changes. The medial meniscus is crucial for load distribution and stability of the knee, and cyst formation can lead to pain, swelling, and restricted movement. Patients may present with symptoms such as joint effusion, mechanical symptoms like locking or catching, and pain localized to the medial aspect of the knee. Diagnosis typically involves imaging studies such as MRI, which can reveal the presence of a cyst and any associated meniscal tears. Treatment may involve conservative management, including physical therapy and corticosteroid injections, or surgical intervention such as arthroscopy to remove the cyst or repair the meniscus. Accurate coding is essential for proper reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms of cystic meniscus
  • Need for precise imaging documentation
  • Differentiation from other knee pathologies
  • Potential for concurrent ligament injuries

Audit Risk Factors

  • Inadequate documentation of symptoms and imaging findings
  • Failure to specify the laterality of the condition
  • Misclassification of the type of meniscal injury
  • Lack of documentation for conservative treatment attempts

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with knee pain and swelling, often after an injury or with chronic degeneration.

Billing Considerations

Ensure that all imaging studies are clearly documented and that any surgical interventions are linked to the diagnosis.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and treatment progress.

Common Clinical Scenarios

Patients undergoing rehabilitation post-meniscal surgery or with chronic knee pain.

Billing Considerations

Document the patient's functional status and response to therapy to support the coding of associated conditions.

Coding Guidelines

Inclusion Criteria

Use M23.004 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant imaging findings and treatment plans
  • The code should be used when the cystic meniscus is confirmed and no other specific meniscal injury is documented

Exclusion Criteria

Do NOT use M23.004 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

29881CPT Code

Arthroscopy, knee, surgical; with meniscectomy, medial or lateral

Clinical Scenario

Used when surgical intervention is required for cyst removal or meniscal repair.

Documentation Requirements

Document the indication for surgery, findings during the procedure, and any postoperative care.

Specialty Considerations

Orthopedic surgeons should ensure that the surgical report clearly correlates with the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like cystic meniscus, improving the accuracy of patient records and reimbursement processes. This specificity helps in tracking treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like cystic meniscus, improving the accuracy of patient records and reimbursement processes. This specificity helps in tracking treatment outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. This specificity helps in tracking treatment outcomes and resource allocation.

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 is the difference between cystic meniscus and meniscal tear?

Cystic meniscus refers to a fluid-filled cyst within the meniscus, while a meniscal tear is a disruption of the meniscal tissue. Both can cause knee pain but require different management approaches.