ICD-10 Knee Pain Code Guide
One of the most injury prone areas of the body is the knee. Whether through sport, normal activity, or advancing age, knee pain and injury inflicts the majority of individuals throughout their lifetime. Most treatment for knee pain or injury is conducted in collaboration between physicians and physical therapists because each play such a significant role in making sure that their patients knees are functioning properly and that they are able to move through life without pain.
In this next ICD-10 code guide from PatientStudio, we are going to consider many of the most common knee injuries, why they arise, how they are commonly treated, and most importantly give you a comprehensive list of the ICD-10 codes that are used in their treatment.
Anterior Cruciate Ligament (ACL) Injury
Usually, anterior cruciate ligament injuries are caused by tears or sprains of the ligament (ACL). The ACL is a ligament that connects the thighbone (femur) to the shinbone (tibia) in the knee joint and helps stabilize it. The most common type of knee injury occurs during sports activities that involve sudden stops and changes of direction, jumping, and landing, such as soccer, basketball, football, and downhill skiing. One of the main symptoms of this condition is a loud "pop" or "popping" sensation in the knee. Aside from loss of full range of motion, swelling, tenderness along the joint line, discomfort when walking, and inability to continue activities are other symptoms. An examination of all the structures of the injured knee will be conducted to diagnose this condition. A diagnostic imaging test, such as an X-ray or magnetic resonance imaging (MRI), may also be performed. Rest, bracing, physical therapy, and rehabilitation exercises can be used to regain strength and stability after a ruptured ACL, depending on the severity of the injury. The anterior cruciate ligament can be rebuilt surgically in severe cases.
Injuries to the ACL are coded in ICD-10 as follows –
S83.51 Sprain of anterior cruciate ligament of knee
S83.511 Sprain of anterior cruciate ligament of right knee
S83.511A …… initial encounter
S83.511D …… subsequent encounter
S83.511S …… sequela
S83.512 Sprain of anterior cruciate ligament of left knee
S83.512A …… initial encounter
S83.512D …… subsequent encounter
S83.512S …… sequela
S83.519 Sprain of anterior cruciate ligament of unspecified knee
S83.519A …… initial encounter
S83.519D …… subsequent encounter
S83.519S …… sequela
Iliotibial Band Syndrome
A common cause of lateral knee pain in runners and cyclists, iliotibial band syndrome (ITBS) is an overuse injury to the connective tissues located on the side of the thighs and knees. There is pain and tenderness in the region, especially above the knee joint, as a result of this condition. The IT band is typically overly tight and rubs against each bone, causing ITBS, an overuse injury from repetitive movements. One of the most common symptoms of this condition is chronic pain on the lateral side of the knee. An evaluation of the medical history and a physical examination are used to diagnose IT band syndrome. Certain types of body assessments may be performed by physicians or physical therapists by requiring patients to perform certain exercises to demonstrate movement patterns, strength, and stability. A pelvic alignment assessment and IT band tightness assessment may be conducted. MRI scans, ultrasounds, X-rays, and other diagnostic imaging tests may also be conducted in some cases. There are a number of options available for treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs), icing, stretching, and strengthening exercises generally performed within the physical therapy setting as well as at home.
ITBS related ICD-10 codes include –
M76.3 Iliotibial band syndrome
M76.30 Iliotibial band syndrome, unspecified leg
M76.31 Iliotibial band syndrome, right leg
M76.32 Iliotibial band syndrome, left leg
Meniscal Tear
Torn meniscus is a common knee injury that occurs when the cartilage tears. In the leg, the meniscus is a piece of cartilage that provides cushioning between the femur and tibia (shinbone). Whenever the knee joint is forced to twist or rotate forcefully, such as when exerting full weight, the meniscus tears. In general, a torn meniscus is diagnosed by moving the knees and legs in various directions during a physical examination. Additionally, this helps pinpoint the exact cause of symptoms and diagnose the extent of movement. The knee joint can become stiff and painful if the meniscus is torn and not treated. Occasionally, patients may experience difficulty extending their knees fully due to a block to knee motion. Depending on the type, size, and location of the tear, treatment for a torn meniscus may vary from person to person. A combination of rest, physical therapy, over-the-counter medications, and surgical procedures such as arthroscopy is used to treat the condition. Normally, patients are instructed to rest and avoid twisting, rotating, and pivoting their knees to avoid aggravating the pain. Orthopedists may recommend meniscus transplants or knee replacement surgeries for patients with advanced stages of the disease.
ICD-10 codes associated with meniscal tears:
S83.2 Tear of meniscus, current injury
S83.20 Tear of unspecified meniscus, current injury
S83.200 Bucket-handle tear of unspecified meniscus, current injury, right knee
S83.200A …… initial encounter
S83.200D …… subsequent encounter
S83.200S …… sequela
S83.201 Bucket-handle tear of unspecified meniscus, current injury, left knee
S83.201A …… initial encounter
S83.201D …… subsequent encounter
S83.201S …… sequela
S83.202 Bucket-handle tear of unspecified meniscus, current injury, unspecified knee
S83.202A …… initial encounter
S83.202D …… subsequent encounter
S83.202S …… sequela
S83.203 Other tear of unspecified meniscus, current injury, right knee
S83.203A …… initial encounter
S83.203D …… subsequent encounter
S83.203S …… sequela
S83.204 Other tear of unspecified meniscus, current injury, left knee
S83.204A …… initial encounter
S83.204D …… subsequent encounter
S83.204S …… sequela
S83.205 Other tear of unspecified meniscus, current injury, unspecified knee
S83.205A …… initial encounter
S83.205D …… subsequent encounter
S83.205S …… sequela
S83.206 Unspecified tear of unspecified meniscus, current injury, right knee
S83.206A …… initial encounter
S83.206D …… subsequent encounter
S83.206S …… sequela
S83.207 Unspecified tear of unspecified meniscus, current injury, left knee
S83.207A …… initial encounter
S83.207D …… subsequent encounter
S83.207S …… sequela
S83.209 Unspecified tear of unspecified meniscus, current injury, unspecified knee
S83.209A …… initial encounter
S83.209D …… subsequent encounter
S83.209S …… sequela
S83.21 Bucket-handle tear of medial meniscus, current injury
S83.211 Bucket-handle tear of medial meniscus, current injury, right knee
S83.211A …… initial encounter
S83.211D …… subsequent encounter
S83.211S …… sequela
S83.212 Bucket-handle tear of medial meniscus, current injury, left knee
S83.212A …… initial encounter
S83.212D …… subsequent encounter
S83.212S …… sequela
S83.219 Bucket-handle tear of medial meniscus, current injury, unspecified knee
S83.219A …… initial encounter
S83.219D …… subsequent encounter
S83.219S …… sequela
S83.22 Peripheral tear of medial meniscus, current injury
S83.221 Peripheral tear of medial meniscus, current injury, right knee
S83.221A …… initial encounter
S83.221D …… subsequent encounter
S83.221S …… sequela
S83.222 Peripheral tear of medial meniscus, current injury, left knee
S83.222A …… initial encounter
S83.222D …… subsequent encounter
S83.222S …… sequela
S83.229 Peripheral tear of medial meniscus, current injury, unspecified knee
S83.229A …… initial encounter
S83.229D …… subsequent encounter
S83.229S …… sequela
S83.23 Complex tear of medial meniscus, current injury
S83.231 Complex tear of medial meniscus, current injury, right knee
S83.231A …… initial encounter
S83.231D …… subsequent encounter
S83.231S …… sequela
S83.232 Complex tear of medial meniscus, current injury, left knee
S83.232A …… initial encounter
S83.232D …… subsequent encounter
S83.232S …… sequela
S83.239 Complex tear of medial meniscus, current injury, unspecified knee
S83.239A …… initial encounter
S83.239D …… subsequent encounter
S83.239S …… sequela
S83.24 Other tear of medial meniscus, current injury
S83.241 Other tear of medial meniscus, current injury, right knee
S83.241A …… initial encounter
S83.241D …… subsequent encounter
S83.241S …… sequela
S83.242 Other tear of medial meniscus, current injury, left knee
S83.242A …… initial encounter
S83.242D …… subsequent encounter
S83.242S …… sequela
S83.249 Other tear of medial meniscus, current injury, unspecified knee
S83.249A …… initial encounter
S83.249D …… subsequent encounter
S83.249S …… sequela
S83.25 Bucket-handle tear of lateral meniscus, current injury
S83.251 Bucket-handle tear of lateral meniscus, current injury, right knee
S83.251A …… initial encounter
S83.251D …… subsequent encounter
S83.251S …… sequela
S83.252 Bucket-handle tear of lateral meniscus, current injury, left knee
S83.252A …… initial encounter
S83.252D …… subsequent encounter
S83.252S …… sequela
S83.259 Bucket-handle tear of lateral meniscus, current injury, unspecified knee
S83.259A …… initial encounter
S83.259D …… subsequent encounter
S83.259S …… sequela
S83.26 Peripheral tear of lateral meniscus, current injury
S83.261 Peripheral tear of lateral meniscus, current injury, right knee
S83.261A …… initial encounter
S83.261D …… subsequent encounter
S83.261S …… sequela
S83.262 Peripheral tear of lateral meniscus, current injury, left knee
S83.262A …… initial encounter
S83.262D …… subsequent encounter
S83.262S …… sequela
S83.269 Peripheral tear of lateral meniscus, current injury, unspecified knee
S83.269A …… initial encounter
S83.269D …… subsequent encounter
S83.269S …… sequela
S83.27 Complex tear of lateral meniscus, current injury
S83.271 Complex tear of lateral meniscus, current injury, right knee
S83.271A …… initial encounter
S83.271D …… subsequent encounter
S83.271S …… sequela
S83.272 Complex tear of lateral meniscus, current injury, left knee
S83.272A …… initial encounter
S83.272D …… subsequent encounter
S83.272S …… sequela
S83.279 Complex tear of lateral meniscus, current injury, unspecified knee
S83.279A …… initial encounter
S83.279D …… subsequent encounter
S83.279S …… sequela
S83.28 Other tear of lateral meniscus, current injury
S83.281 Other tear of lateral meniscus, current injury, right knee
S83.281A …… initial encounter
S83.281D …… subsequent encounter
S83.281S …… sequela
S83.282 Other tear of lateral meniscus, current injury, left knee
S83.282A …… initial encounter
S83.282D …… subsequent encounter
S83.282S …… sequela
S83.289 Other tear of lateral meniscus, current injury, unspecified knee
S83.289A …… initial encounter
S83.289D …… subsequent encounter
S83.289S …… sequel
Osteoarthritis of the knee
The most common cause of osteoarthritis of the knee is aging. Most people will develop osteoarthritis at some point in their lives. Significant arthritis can develop at an earlier age due to several factors. Physical therapy or a doctor's examination will be the first step in diagnosing knee osteoarthritis. A medical history and any symptoms you may have will also be taken by your doctor. An MRI scan may be ordered when X-rays do not reveal a clear reason for joint pain or if the X-rays indicate damage to other types of joint tissue. Tests of the blood may be used to rule out other conditions that could be causing the pain, such as rheumatoid arthritis, a different type of arthritis caused by an immune system disorder. Knee osteoarthritis is primarily treated to relieve pain and restore mobility. Physical and occupational therapy, as well as weight loss and exercise, are usually part of the treatment plan. Your doctor can perform arthroscopy, osteotomy, or arthroplasty to treat osteoarthritis in the knee.
Common ICD-10 codes related to Osteoarthritis of the knee include:
M17 Osteoarthritis of knee
M17.0 Bilateral primary osteoarthritis of knee
M17.1 Unilateral primary osteoarthritis of knee
M17.10 Unilateral primary osteoarthritis, unspecified knee
M17.11 Unilateral primary osteoarthritis, right knee
M17.12 Unilateral primary osteoarthritis, left knee
M17.2 Bilateral post-traumatic osteoarthritis of knee
M17.3 Unilateral post-traumatic osteoarthritis of knee
M17.30 Unilateral post-traumatic osteoarthritis, unspecified knee
M17.31 Unilateral post-traumatic osteoarthritis, right knee
M17.32 Unilateral post-traumatic osteoarthritis, left knee
M17.4 Other bilateral secondary osteoarthritis of knee
M17.5 Other unilateral secondary osteoarthritis of knee
M17.9 Osteoarthritis of knee, unspecified
Patellofemoral (Kneecap) Pain
An injury to the front of the knee, around the kneecap (patella), is known as patellofemoral pain syndrome (PFPS). The condition more commonly called runner's knee is more frequently observed among those who participate in exercises involving jumping and running. It is important to note, however, that PFPS can also affect non-athletes. The front of the knee is usually affected by a dull, aching pain. Kneeling down, sitting for long periods of time, climbing stairs, squatting, and doing other normal daily activities can be extremely difficult with this condition because of the severe pain and stiffness that results. Factors causing the pain condition are unknown. There are, however, several factors that may contribute to the development of this condition, including muscle imbalances or weaknesses, overuse (from vigorous athletics or training), problems with the alignment of the kneecap, and prior knee surgeries. Resting the knee as much as possible and applying ice to the knee area are usually the first steps in treating this condition. Additionally, medications, physical therapy exercises, and braces can be recommended. When non-surgical treatments do not work, physicians may recommend surgical procedures like arthroscopy and realignment (realigning the angle of the knee cap or relieving pressure on the cartilage).
PFPS is diagnosed with the following ICD-10 codes:
M22 – Disorder of patella
M22.0 – Recurrent dislocation of patella
M22.00 – Recurrent dislocation of patella, unspecified knee
M22.01 – Recurrent dislocation of patella, right knee
M22.02 – Recurrent dislocation of patella, left knee
M22.1 – Recurrent subluxation of patella
M22.10 – Recurrent subluxation of patella, unspecified knee
M22.11 – Recurrent subluxation of patella, right knee
M22.12 – Recurrent subluxation of patella, left knee
M22.2 – Patellofemoral disorders
M22.2X – Patellofemoral disorders
M22.2X1 – Patellofemoral disorders, right knee
M22.2X2 – Patellofemoral disorders, left knee
M22.2X9 – Patellofemoral disorders, unspecified knee
M22.3 – Other derangements of patella
M22.3X – Other derangements of patella
M22.3X1 – Other derangements of patella, right knee
M22.3X2 – Other derangements of patella, left knee
M22.3X9 – Other derangements of patella, unspecified knee
M22.4 – Chondromalacia patellae
M22.40 – Chondromalacia patellae, unspecified knee
M22.41- Chondromalacia patellae, right knee
M22.42 – Chondromalacia patellae, left knee
M22.8 – Other disorders of patella
M22.8X – Other disorders of patella
M22.8X1 – Other disorders of patella, right knee
M22.8X2 – Other disorders of patella, left knee
M22.8X9 – Other disorders of patella, unspecified knee
M22.9 – Unspecified disorder of patella
M22.90 – Unspecified disorder of patella, unspecified kne
M22.91 – Unspecified disorder of patella, right knee
M22.92 – Unspecified disorder of patella, left knee
Patellar Tendinitis
Patellar tendinitis is an inflammation or injury to the tendon that connects the kneecap (patella) to the shinbone (tibia). Your patellar tendon extends your knee and allows people to run, jump, and kick with the muscles in your thigh. Athletes whose sports activities involve frequent jumping, such as basketball and volley ball, are more likely to develop jumper's knee. It is possible for people who do not engage in these sports activities to suffer from this condition as well. It has been reported that between 40% and 50% of elite volleyball players suffer from jumper's knee. Overuse of the knees in sports or exercise causes the condition, which is most often caused by repetitive stress. Inflammation and weakening of the tendons may result from repetitive stress on the knees. The condition's initial symptoms include pain and tenderness around the kneecap base. Kneecap swelling and a burning sensation are also common symptoms. Initial pain may be irregular, appearing only after exercise or sports. The pain can become progressively worse as the tendon becomes more damaged. By bending and extending the leg, physicians can check the range of knee motion and locate the specific area of pain. The severity of tendon or bone damage can be determined by imaging tests such as X-Rays, MRIs, and ultrasounds. The severity and extent of the injury determine the treatment for this condition. Treatment will start with conservative measures such as over-the-counter (OTC) drugs, physical therapy, and injections. Patients should avoid activities that put force on their knees during a period of controlled rest, as advised by physicians. In the event that conservative measures fail to produce the desired results, surgery to repair the patellar tendon may also be considered.
The following ICD-10 codes are related to this condition:
M76.5 Patellar tendinitis
M84.36 Stress fracture, tibia and fibula
M84.361 Stress fracture, right tibia
M84.361A Stress fracture, right tibia, initial encounter for fracture
M84.361D Stress fracture, right tibia, subsequent encounter for fracture with routine healing
M84.361G Stress fracture, right tibia, subsequent encounter for fracture with delayed healing
M84.361K Stress fracture, right tibia, subsequent encounter for fracture with nonunion
M84.361P Stress fracture, right tibia, subsequent encounter for fracture with malunion
M84.361S Stress fracture, right tibia, sequela
M84.362 Stress fracture, left tibia
M84.362A Stress fracture, left tibia, initial encounter for fracture
M84.362D Stress fracture, left tibia, subsequent encounter for fracture with routine healing
M84.362G Stress fracture, left tibia, subsequent encounter for fracture with delayed healing
M84.362K Stress fracture, left tibia, subsequent encounter for fracture with nonunion
Posterior Cruciate Ligament (PCL) Injury
Located in the back of the knee, the posterior cruciate ligament (PCL) holds the tibia (shinbone) in place by preventing it from moving backward. The posterior cruciate ligament can be injured by a hard blow to the shinbone below the knee or by falling on the bent knee. The ligament may suffer from a minor tear that causes severe pain, swelling, and instability. Motor vehicle accidents and contact sports like football and soccer are the most common causes of these injuries. This condition is characterized by pain, swelling, and instability. In the beginning, these symptoms are mild; however, as the condition progresses, they worsen and cause knee instability. As part of an initial physical exam, the physician or therapist may press and examine the knees to determine if they are injured, loose, or if fluid is present within the joint due to bleeding. Depending on the condition, they may examine the movement of the knees, leg, or foot in different directions. Knee joints are typically examined with imaging tests such as X-rays, MRI scans, and arthroscopy (a surgical procedure). The severity and extent of the injury determine the treatment. Pain relief medications such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium are common treatment modalities. A severe injury (especially if it occurs in conjunction with other torn knee ligaments) may require surgery to reconstruct the ligaments. The knee can be operated on arthroscopically by inserting a fiber-optic camera and other surgical tools through a small incision.
The following ICD-10 codes are related to this condition:
S83.52 Sprain of posterior cruciate ligament of knee
S83.521 Sprain of posterior cruciate ligament of right knee
S83.521A …… initial encounter
S83.521D …… subsequent encounter
S83.521S …… sequela
S83.522 Sprain of posterior cruciate ligament of left knee
S83.522A …… initial encounter
S83.522D …… subsequent encounter
S83.522S …… sequela
S83.529 Sprain of posterior cruciate ligament of unspecified knee
S83.529A …… initial encounter
S83.529D …… subsequent encounter
S83.529S …… sequela
Knee Replacement (Arthroplasty)
There are three compartments in the knee joint: medial (inside of the knee), lateral (outside of the knee) and patellofemoral (front of the knee). The UKA [also known as partial knee replacement] involves replacing damaged parts of the knee in one of its compartments. Patients with arthritis in the medial or lateral compartments of the knee may benefit from this minimally invasive partial knee replacement. Partially replacing the damaged knee means replacing only one compartment. The anterior and posterior cruciate ligaments are preserved, while damaged joint or bone tissue in the knee joint is replaced with a man-made prosthetic. As a result of the smaller implants, a partial replacement requires a smaller incision. Additionally, UKA may result in less postoperative pain and a shorter recovery period. For patients who show bilateral pain and arthritis in all knee compartments, a TKA [total knee replacement] is often recommended. Both UKA and TKA are surgical procedures that are frequently followed up by extensive physical therapy.
Arthroplasty is coded using CPT codes, but physical therapy after treatment is coded using Z codes from the ICD-10 as follows:
Z47.89 Encounter for other orthopedic aftercare
Z47.1 Aftercare following joint replacement surgery
Z96.651, Status (post), organ replacement, by artificial or mechanical device or prosthesis of, joint, knee-see presence of knee joint implant
R26.9 Abnormality, gait
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