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ICD-10 Guide
ICD-10 CodesM02.261

M02.261

Billable

Postimmunization arthropathy, right knee

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

Code Description

ICD-10 M02.261 is a billable code used to indicate a diagnosis of postimmunization arthropathy, right knee.

Key Diagnostic Point:

Postimmunization arthropathy refers to joint pain and inflammation that occurs following vaccination. In the case of the right knee, this condition may manifest as swelling, stiffness, and pain localized to the knee joint, which is comprised of the femur, tibia, fibula, and patella, along with associated ligaments, tendons, and cartilage. The pathophysiology involves an immune-mediated response triggered by the vaccine, leading to synovitis and potential damage to the articular cartilage. Clinically, patients may present with limited range of motion, difficulty bearing weight, and tenderness upon palpation of the knee joint. The onset of symptoms typically occurs within days to weeks following vaccination, and while self-limiting in many cases, some patients may require further intervention such as physical therapy or corticosteroid injections to manage symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of immunological responses to vaccines
  • Involves specific anatomical knowledge of the knee joint
  • Differentiation from other forms of arthropathy
  • Documentation of vaccination history is critical

Audit Risk Factors

  • Inadequate documentation of vaccination history
  • Failure to specify laterality (right knee)
  • Misclassification as a primary arthritic condition without evidence of postimmunization
  • Lack of detailed clinical notes regarding joint examination

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients may present with acute knee pain post-vaccination, requiring evaluation for potential joint effusion or ligamentous injury.

Billing Considerations

Orthopedic specialists should document the severity of joint involvement and any functional limitations impacting daily activities.

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 systemic symptoms alongside localized knee pain, necessitating a broader evaluation for autoimmune conditions.

Billing Considerations

Consideration of systemic involvement and monitoring for potential progression to chronic arthropathy is essential.

Physical Medicine

Documentation Requirements

Functional assessments should focus on mobility, pain levels, and rehabilitation needs, including any assistive devices used.

Common Clinical Scenarios

Patients may require physical therapy to restore function and alleviate pain, particularly if mobility is significantly affected.

Billing Considerations

Documentation should reflect the impact of joint pain on activities of daily living and the need for adaptive strategies.

Coding Guidelines

Inclusion Criteria

Use M02.261 When
  • 10 coding guidelines require specificity in laterality (right knee) and the need for thorough documentation of the patient's vaccination history and clinical presentation
  • Encounter type (initial vs
  • follow
  • up) also influences coding

Exclusion Criteria

Do NOT use M02.261 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 therapeutic injection of corticosteroids in the right knee to manage inflammation.

Documentation Requirements

Document the indication for the procedure, the amount of fluid aspirated, and any medications injected.

Specialty Considerations

Orthopedic and rheumatologic considerations for joint injections.

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, including postimmunization arthropathy, which aids in better tracking and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, including postimmunization arthropathy, which aids in better tracking and management of these conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, including postimmunization arthropathy, which aids in better tracking and management of these conditions.

Resources

Clinical References

  • •
    CDC Immunization Guidelines

Coding & Billing References

  • •
    CDC Immunization Guidelines

Frequently Asked Questions

What documentation is necessary to support the diagnosis of postimmunization arthropathy?

Documentation should include the date and type of vaccination, onset of symptoms, clinical examination findings, and any imaging or laboratory results that support the diagnosis.