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ICD-10 Guide
ICD-10 CodesM22.41

M22.41

Billable

Chondromalacia patellae, right knee

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

Code Description

ICD-10 M22.41 is a billable code used to indicate a diagnosis of chondromalacia patellae, right knee.

Key Diagnostic Point:

Chondromalacia patellae refers to the softening and breakdown of the cartilage on the underside of the kneecap (patella). This condition is often associated with knee pain, particularly in the anterior region, and can result from overuse, injury, or misalignment of the knee joint. Patients may experience symptoms such as a grinding sensation during movement, swelling, and difficulty with activities that involve bending the knee, such as climbing stairs or squatting. The right knee designation indicates that the condition is localized to the right side. Chondromalacia is commonly seen in athletes and individuals who engage in repetitive knee activities. Diagnosis typically involves a combination of physical examination, patient history, and imaging studies such as MRI or X-rays to assess cartilage integrity. Treatment options may include physical therapy, anti-inflammatory medications, and in some cases, arthroscopic surgery to repair or smooth the damaged cartilage. Understanding the nuances of this condition is crucial for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between chondromalacia and other knee conditions such as meniscal tears or ligament injuries.
  • The need for precise documentation of symptoms and imaging findings.
  • Variability in treatment approaches that may affect coding.
  • Potential for co-existing conditions that complicate the coding process.

Audit Risk Factors

  • Inadequate documentation of the patient's symptoms and history.
  • Failure to specify laterality (right knee) in the documentation.
  • Misclassification of chondromalacia as a more severe condition.
  • Lack of imaging studies to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with knee pain, particularly athletes or active individuals.

Billing Considerations

Documentation should clearly differentiate between chondromalacia and other knee injuries.

Physical Therapy

Documentation Requirements

Progress notes detailing treatment interventions and patient response.

Common Clinical Scenarios

Rehabilitation following arthroscopic surgery for chondromalacia.

Billing Considerations

Focus on functional outcomes and improvement in range of motion.

Coding Guidelines

Inclusion Criteria

Use M22.41 When
  • According to ICD
  • 10 guidelines, M22
  • 41 should be used when the diagnosis of chondromalacia patellae is confirmed and documented
  • It is important to include details about the patient's symptoms and any imaging studies that support the diagnosis

Exclusion Criteria

Do NOT use M22.41 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

29881CPT Code

Arthroscopy, knee, diagnostic, with or without synovial biopsy

Clinical Scenario

Used when performing arthroscopy to assess chondromalacia.

Documentation Requirements

Document the indication for the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure detailed operative notes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of chondromalacia patellae, improving the accuracy of diagnoses and treatment tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of chondromalacia patellae, improving the accuracy of diagnoses and treatment tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of chondromalacia patellae, improving the accuracy of diagnoses and treatment tracking.

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 primary cause of chondromalacia patellae?

Chondromalacia patellae is primarily caused by overuse, injury, or misalignment of the knee joint, leading to cartilage degeneration.