A left knee pain ICD 10 code is used regularly by physical therapists as the condition is common and has several causes. Osteoarthritis, one common cause of left knee pain, for example, was found in the knees of more than 22% of individuals forty years of age and older according to a large meta-analysis published in 2020. Sports injuries are another common cause of knee pain. In fact, a 10-year study published in 2006 gathered data from over 17,000 athletes and found that 37% of them experienced an injury to their knee.
Other potential causes of knee pain include:
- ACL/MCL/PCL/LCL sprain or tear
- Patellofemoral syndrome
- Patellar dislocation
- Patellar chondromalacia
- Patellar tendinitis
- IT band syndrome
- Meniscus injury
- Rheumatoid arthritis
As you can see, with so many conditions affecting the knee, the ability to assess and treat left knee pain is an important skill for any physical therapist. Whether acute, chronic or recurrent, knee pain can have a significant impact on functional mobility and quality of life and since you will likely encounter this symptom in your practice, understanding how to correctly use a left knee pain ICD 10 code is important. Proper coding is essential to communicate that treatments are medically necessary and will help minimize claim denials. To help you in this endeavor, this article will guide you to select the most appropriate left knee pain ICD 10 code.
If you, like many therapists, have some experience searching for and selecting a left knee pain ICD 10 code but don’t have a good understanding of the who, what, when and why these codes are used, see the next section for an left knee pain ICD-10 code primer. Following this introduction we will discuss the left knee pain ICD10 code in more detail.
An introduction to the left knee pain ICD-10 codes
All HIPAA-covered entities are required to submit ICD-10 codes if seeking reimbursement for services from an insurance company. This includes physical therapists.
The International Classification of Disease, 10th Revision (ICD-10) is a set of diagnosis, symptom, and procedure codes that physical therapists use daily in their practice. In 2015 physical therapists and all other HIPAA-covered healthcare providers transitioned from the ICD-9 to the current version, ICD-10. ICD-10 codes are alphanumeric codes. They begin with a letter and are always between three and seven characters with a decimal point placed after the third character. The more characters it has, the more specific it is.
Each code follows the following structure:
Characters 1-3 indicate the category of the diagnosis;
Characters 4-6 indicate etiology, anatomic site, severity or other clinical detail;
Character 7 is an extension value, for example:
A: initial encounter (anything related to care of the initial injury);
D: subsequent encounter (anything related to the phase of routine care of the injury while the patient recovers–this usually refers to rehabilitation);
S: sequela (other conditions that may result from the presence of the primary condition).
Note, for fracture care, there are several more extensions (example: P, G, K, which signify malunion, delayed healing, or nonunion for a subsequent encounter).
ICD-10 codes must be submitted with relevant documentation whenever reimbursement is sought for covered services either by the healthcare entity itself or by a patient.
While it may seem like an extra step in an already detailed process of documentation and billing, ICD-10 codes are required for a specific reason. Not only do they identify a medical diagnosis, but perhaps more importantly, they help insurance companies understand why the care you are providing is medically necessary and therefore, reimbursable.
Left knee pain ICD 10 code: M25.562
This left knee pain ICD 10 code should be utilized whenever a patient is presenting with pain in their left knee that will be the focus of part or all of your interventions. As you can see, this code has six characters.
When selecting the left knee pain ICD 10 code, the code with the highest number of applicable characters should be chosen, at least on the first visit. Greater specificity is more likely to lead to reimbursement but it should always be supported by the patient’s medical record and clinical knowledge of the patient’s condition. Many three- and even sometimes four-digit codes can be found for a given condition when searching a reputable database like ICD10 Data, but if a more detailed code is available, this code may not be reimbursable by insurance.
Is the left knee pain ICD 10 code billable?
Yes, M25.562 (Pain in left knee) is considered specific enough to be utilized to indicate a diagnosis for billing/reimbursement purposes. The parent code M25.5 (pain in joint) is considered too nonspecific for billing which is why it is important to look for codes with more characters that can provide more detail.
When is an alternative left knee pain ICD 10 code more appropriate?
In this case, there are no other codes that specifically describe pain or discomfort in the left knee joint. However, there may be cases where an additional diagnosis code would be utilized alongside M25.562 to describe a condition or injury of the knee that has led to this pain. Due to the numerous potential causes of knee pain, this list is nowhere near exhaustive. Utilizing a reputable resource like ICD 10 Data to search for the condition you are looking for can help you identify pertinent codes.
Some examples of relevant codes in this case, however, are as follows:
S87.02XA: Crushing injury of the left knee, initial encounter
S83.242D: Other tear of medial meniscus, current injury, left knee, subsequent encounter
M17.12: Unilateral primary osteoarthritis, left knee
M22.2X2: Patellofemoral disorders, left knee
Additional left knee pain ICD 10 code considerations
As you can see, even a simple case can present a host of left knee pain ICD 10 code choices if you choose to include the cause of knee pain in your list of diagnosis codes. When selecting a left knee pain ICD 10 code, here are some additional considerations to help with successful reimbursement:
Place of occurrence codes (Y92): Place of occurrence codes may be used during the initial evaluation to increase specificity of the primary diagnosis.
Example 1: Left knee pain in military personnel
- Y92.84 Military training ground as the place of occurrence of the external cause
Example 2: Left knee pain in a injured high school soccer player
- Y92.213 High school as the place of occurrence of the external cause
External cause codes (V00-Y99): specify an external cause resulting in the episode of left knee pain and may be used during the initial evaluation to increase specificity of the primary diagnosis
Example 1: Overuse or overtraining as the cause of knee pain
- X50.3XXA Overexertion and strenuous or repetitive movements, initial encounter
Example 2: Collision with another soccer player
- W03.XXXA Other fall on same level due to collision with another person, initial encounter
Stay current on the left knee pain ICD 10 code
The Centers for Medicare and Medicaid Services publish an updated list of codes each year to go into effect October 1 and remain in effect until September 30 of the following year. Sites like ICD10 Data can also be helpful in identifying code changes once they update their list as announced on their homepage.
If you’re struggling with left knee pain ICD 10 codes, TheraPlatform, a practice management, teletherapy and EHR all-in-software for therapists can help. They have a list of ICD-10 codes and can also help you manage administrative tasks like scheduling, documentation, billing and more. They also offer a free 30-day trial with no credit card required.
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