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ICD-10 Guide
DiagnosesRight Knee Effusion

Right Knee Effusion

ICD-10 Coding for Right Knee Effusion(M25.461)

PRIMARY SPECIALTYRheumatology
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Right Knee Effusion?
Essential facts and insights about Right Knee Effusion

Key Clinical Considerations:

  • Swelling around the right knee
  • Pain and tenderness in the knee joint
  • Limited range of motion
  • Joint stiffness
  • Warmth or redness over the knee

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history including onset and duration of symptoms
  • Physical examination findings detailing swelling and range of motion
  • Results of imaging studies (e.g., X-ray, MRI) if performed
  • Assessment of underlying causes (e.g., arthritis, trauma)

Coding Guidelines

Usage Guidelines & Examples

  • Usage guidelines: Use specific codes for right knee effusion based on clinical findings.
  • Common errors: Misclassifying effusion as a symptom rather than a diagnosis.

Code Exclusions

Important Exclusions

  • Excluded conditions: Left knee effusion, other joint effusions.
  • Alternative codes: Codes for underlying conditions such as osteoarthritis or trauma.

Related ICD-10 Codes

Primary Codes
719.46
Effusion, right knee
713.5
Joint effusion, unspecified
Ancillary Codes
M71.231
Differential Codes
M17.11
S83.0XXA

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Rheumatology

Specialty Applications

  • Patient populations: Adults with arthritis, athletes with knee injuries, elderly patients.
  • Clinical settings: Rheumatology clinics, orthopedic practices, urgent care.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

Documentation requirements?

Include detailed patient history, physical exam findings, and any imaging results.

Billing considerations?

Ensure accurate coding to reflect the specific diagnosis and any associated conditions.