ICD 9 Code for Knee PainICD 9 codes are used to identify the type of illness a person has.  There are hundreds of ICD 9 coded for various illnesses.  ICD 9 codes are used to identify the exact illness a person has and is used for research and for billing purposes.

The ICD 9 code has largely been replaced by the ICD 10 code.  This is because a new code book has come out that changes the code numbers and recognizes different aspects of a particular injury or illness.

ICD 9 Code for the Knee

The ICD 9 diagnostic code for unspecified joint pain in the lower leg is 719.46.  This is a vague code that does not specify which joint is involved and does not tell anyone about the other aspects of the joint pain that might be important in identifying the injury.  It also works only for those injuries that occurred on or before September 30, 2015.  If the injury occurred after that date, then the ICD 10 code is used instead.

The ICD 9 code can be used for any one of the following injuries:

  • Chronic left knee joint pain
  • Chronic right knee joint pain
  • Bilateral patellofemoral syndrome
  • Bilateral lower leg joint pain
  • Bilateral knee joint pain lasting longer than 3 months
  • Bilateral knee joint pain lasting less than 3 months
  • Arthralgia of the lower leg
  • Arthralgia of the knee occurring less than 3 months
  • Arthralgia (joint pain) of any joint in the lower leg
  • Knee joint pain
  • Right knee joint pain
  • Left knee joint pain
  • Left patellofemoral syndrome
  • Right patellofemoral syndrome
  • Knee pain with effusion
  • Musculoskeletal pain around the knee
  • Acute knee pain

As you can see, the ICD 9 code of 719.4 covers a wide range of symptoms and signs and does not specifically tell the coder or the insurance company the exact injury or illness going on with the knee.  In order to get around this, some coders use more specific qualifiers to narrow down the illness to a specific illness or injury of the knee.  For example, if the knee pain is from rheumatoid arthritis, the coder can code for rheumatoid arthritis of the knee, which is more specific than just saying “joint pain of the lower leg”.

As the code is part of how the disease is billed for, it pays to know exactly what the ICD 9 code is for a particular knee injury because the payment by the insurance company will be larger.  Knee pain with effusion, for example, is a more complex problem than just “knee pain” and it should be coded to recognize the differences in treatment between the two conditions. In the same way, coding knee pain as rheumatoid arthritis of the knee is better than coding just for knee pain because the treatment is different and the cost of the treatment is different.

ICD 10 Coding

Any injury sustained on or after October 1, 2105 should not be coded using the ICD 9 coding tools but should instead be coded under ICD 10 coding.  The direct translation for “joint pain to the lower extremities” in ICD 9 coding of 719.46 translates to an ICD 10 code of M25.569.  This is the ICD 10 code for pain in the knee, unspecified.  Like ICD 9 coding, there are qualifiers in ICD 10 coding that can help the insurance company further identify exactly what is causing the pain and what other features are used to narrow down the diagnosis.

ICD 9 Code for Knee Pain, hope you found it interesting.

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