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ICD-10 Guide
ICD-10 CodesM02.221

M02.221

Billable

Postimmunization arthropathy, right elbow

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

Code Description

ICD-10 M02.221 is a billable code used to indicate a diagnosis of postimmunization arthropathy, right elbow.

Key Diagnostic Point:

Postimmunization arthropathy refers to joint pain and inflammation that occurs following vaccination. In the case of the right elbow, this condition may manifest as swelling, tenderness, and limited range of motion in the elbow joint. Anatomically, the elbow is a hinge joint formed by the humerus, radius, and ulna, allowing for flexion and extension. The synovial membrane lining the joint can become inflamed due to an immune response triggered by the vaccine, leading to arthritic symptoms. Clinically, patients may present with pain during movement, stiffness, and potential swelling around the joint. The condition is typically self-limiting, resolving within weeks to months, but can significantly impact daily activities and functional mobility during its course.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of immunological responses to vaccines.
  • Involves specific anatomical knowledge of the elbow joint.
  • Differentiation from other forms of arthropathy is necessary.
  • Documentation of laterality is crucial for accurate coding.

Audit Risk Factors

  • Inadequate documentation of immunization history.
  • Failure to specify laterality (right elbow).
  • Misclassification of the condition as a primary arthropathy.
  • Lack of supporting clinical evidence for the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Orthopedic documentation should include imaging studies (e.g., X-rays, MRIs) to rule out other conditions, as well as functional assessments to evaluate range of motion and strength.

Common Clinical Scenarios

Patients may present with post-vaccination elbow pain, requiring evaluation for potential surgical intervention if conservative measures fail.

Billing Considerations

Joint-specific considerations include assessing for any structural damage or chronic conditions that may complicate recovery.

Rheumatology

Documentation Requirements

Rheumatologic documentation should include laboratory tests for inflammatory markers (e.g., ESR, CRP) and assessments of disease activity.

Common Clinical Scenarios

Patients may exhibit autoimmune responses post-vaccination, necessitating a thorough evaluation of systemic involvement.

Billing Considerations

Consideration of other autoimmune conditions that may mimic postimmunization arthropathy is essential.

Physical Medicine

Documentation Requirements

Functional assessments should document mobility limitations and rehabilitation needs, including range of motion and strength testing.

Common Clinical Scenarios

Patients may require physical therapy to restore function and alleviate pain.

Billing Considerations

Assessment of assistive device needs may be necessary for patients with significant mobility limitations.

Coding Guidelines

Inclusion Criteria

Use M02.221 When
  • Official coding guidelines require documentation of laterality (right elbow) and the specific nature of the arthropathy
  • Encounter type (initial, subsequent, or sequela) must also be documented to ensure accurate coding

Exclusion Criteria

Do NOT use M02.221 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits to assess the patient's progress and response to treatment.

Documentation Requirements

Documentation must include history, examination findings, and treatment plan.

Specialty Considerations

Orthopedic and rheumatologic considerations for ongoing management.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of postimmunization arthropathy and its outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of postimmunization arthropathy and its outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of postimmunization arthropathy and its outcomes.

Resources

Clinical References

  • •
    American Academy of Orthopaedic Surgeons Guidelines
  • •
    American College of Rheumatology Recommendations

Coding & Billing References

  • •
    American Academy of Orthopaedic Surgeons Guidelines
  • •
    American College of Rheumatology Recommendations

Frequently Asked Questions

What is postimmunization arthropathy?

Postimmunization arthropathy is a condition characterized by joint pain and inflammation that occurs following vaccination, often resolving spontaneously. It is important to document the immunization history and the specific joint involved for accurate coding.