M25.561: Pain in right knee
Billable ICD-10-CM code, FY2027
What M25.561 covers
M25.561 is for pain in the right knee when no more specific diagnosis is documented. It is a symptom code, often used at a first visit or while the cause is being worked up.
Primary care, orthopedics, sports medicine and physical therapy use it. The left knee is M25.562 and an unspecified side is M25.569. If the cause is known, a diagnosis code usually replaces it, such as M17.11 for primary osteoarthritis of the right knee or an S83.2- code for a current meniscus tear.
Billing and coding notes
Laterality is built into the code, so the side has to match the documentation. ICD-10-CM has no bilateral knee pain code. When both knees hurt, the guidelines say to report the right and left codes, M25.561 and M25.562.
Knee pain that is part of a confirmed diagnosis, such as osteoarthritis of the knee, is not coded separately. If the provider documents the knee pain as chronic, G89.29 may be added.
Related codes under M25.56
Questions about M25.561
How do you code bilateral knee pain?
There is no bilateral code for knee pain, so report both M25.561 (right) and M25.562 (left).
Can M25.561 be coded with M17.11?
Usually not. Pain is a routine part of knee osteoarthritis, and the guidelines say symptoms that are part of a confirmed diagnosis are not coded separately.
ICD-10-CM in CloudMedico
In CloudMedico, a visit's diagnoses come from the current ICD-10-CM list. For US practices, the visit flags a code that isn't billable on its date, and a superbill made from an invoice carries the visit's diagnoses.
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