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v1.0.0
ICD-10 Guide
ICD-10 CodesM22.90

M22.90

Billable

Unspecified disorder of patella, unspecified knee

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

Code Description

ICD-10 M22.90 is a billable code used to indicate a diagnosis of unspecified disorder of patella, unspecified knee.

Key Diagnostic Point:

M22.90 refers to an unspecified disorder of the patella, which is the kneecap, affecting the knee joint. This code is used when the specific nature of the disorder is not clearly defined. Common internal derangements associated with this code may include conditions such as patellar instability, chondromalacia patellae, or patellar tendinopathy. These disorders can lead to pain, swelling, and functional limitations in the knee. Meniscal tears, ligament injuries, and other knee pathologies may coexist but are not specified under this code. The diagnosis often arises from clinical evaluation, imaging studies, and patient history. Treatment may involve conservative management, such as physical therapy and medications, or surgical interventions like arthroscopy, which allows for direct visualization and treatment of the knee joint. Accurate coding is essential for appropriate reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Lack of specificity in the diagnosis
  • Potential overlap with other knee disorders
  • Variability in clinical presentation
  • Need for comprehensive documentation to support the diagnosis

Audit Risk Factors

  • Insufficient documentation to support the unspecified diagnosis
  • Inconsistent use of the code across different providers
  • Failure to document the clinical rationale for using an unspecified code
  • Lack of follow-up documentation or treatment plans

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes, imaging results, and treatment plans must be documented to justify the use of M22.90.

Common Clinical Scenarios

Patients presenting with knee pain without a clear diagnosis, often following trauma or overuse.

Billing Considerations

Orthopedic surgeons should ensure that all potential diagnoses are explored before resorting to an unspecified code.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments and treatment progress notes are essential for justifying the use of this code.

Common Clinical Scenarios

Patients undergoing rehabilitation for knee pain with unclear etiology.

Billing Considerations

Documentation should focus on the impact of the disorder on function and quality of life.

Coding Guidelines

Inclusion Criteria

Use M22.90 When
  • According to ICD
  • 10 guidelines, M22
  • 90 should be used when the specific disorder of the patella is not documented
  • Coders should ensure that all other potential codes have been considered and ruled out before using this unspecified code

Exclusion Criteria

Do NOT use M22.90 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 the physician performs an arthroscopy to evaluate the knee joint for unspecified disorders.

Documentation Requirements

Operative report detailing findings and any interventions performed.

Specialty Considerations

Orthopedic surgeons should ensure that the diagnosis aligns with the findings during the procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding, but M22.90 remains a catch-all for cases where the diagnosis is unclear. Coders must be diligent in ensuring that this code is used appropriately to avoid denials.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding, but M22.90 remains a catch-all for cases where the diagnosis is unclear. Coders must be diligent in ensuring that this code is used appropriately to avoid denials.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding, but M22.90 remains a catch-all for cases where the diagnosis is unclear. Coders must be diligent in ensuring that this code is used appropriately to avoid denials.

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

When should I use M22.90?

Use M22.90 when the specific disorder of the patella is not clearly defined in the clinical documentation, and all other specific codes have been ruled out.