Four Common Overuse Knee Injuries and Their ICD-10 Codes

by | Last updated Dec 10, 2022 | Published on Nov 3, 2020 | Blog, ICD 10 Coding | 0 comments

Knee Injuries
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Joint and other musculoskeletal injuries can occur at any age, particularly for those who engage in repetitive activities. Knee overuse injury is one such common injury. Injuries to the knees generally occur due to performing repetitive motions. Many overuse injuries result from doing too many exercises or activities too soon. On a general mode, exercise and activity can strengthen muscles, bones, tendons and ligaments through a process known as remodeling (the break down and growth of new tissue). However, when the tissues break down faster than it can rebuild, injuries are bound to happen. Overuse knee injuries are generally caused from changing equipment like shoes (for a walker or runner) and using improper training techniques (that can strain certain muscles and joints). Certain medical conditions like flat feet, excessively arched feet, bowlegs, unequal leg length, and poor alignment of the spine, hips, and legs can also increase the likelihood of overuse injuries. Early diagnosis and appropriate treatment are essential to get better outcomes, or else knee injuries can result in pain, swelling and loss of function. Orthopedic medical billing and coding can be challenging for physicians treating knee injuries. Proper documentation is important to ensure appropriate care and for accurate clinical documentation physicians can rely on the service of a reliable medical billing company.

Generally, overuse knee injuries are common in children and adolescents, especially when they repeat the same activity over and over again. Symptoms of the condition can vary based on the type and severity of injury and include – chronic pain, difficulty moving the knee, swelling, loss of sensation, tingling and numbness.

Here discussed are four common overuse knee injuries and their related ICD-10 codes –

Iliotibial Band Syndrome – One of the top causes of lateral knee pain in runners and bicyclists, iliotibial band syndrome (ITBS) is an overuse injury of the connective tissues located on the lateral or outer part of the thighs and knees. The condition causes pain and tenderness in that area, particularly above the knee joint. Typically, an overuse injury from repetitive movements, ITBS is caused by excessive friction from the IT band being overly tight and rubbing against each bone. Chronic pain on the lateral side of the knee is one of the most common symptoms of this condition. IT band syndrome diagnosis primarily begins with a medical history evaluation and physical examination. Physicians may perform certain types of body assessment by having the patient perform certain exercises to demonstrate movement patterns, strength, and stability. They may assess the alignment of the pelvis and tightness of the IT band. In some cases, diagnostic imaging tests like ultrasound, X-ray, or an MRI scan may also be performed. Treatment primarily focuses on conservative approaches like – non-steroidal anti-inflammatory drugs (NSAIDs), icing and stretching and strengthening exercises. 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

Patellofemoral Pain Syndrome (PFPS)Patellofemoral pain syndrome (PFPS) indicates pain in the front of the knee, around the kneecap (patella). Also called runner’s knee, the condition is more common in people who participate in sports activities that involve jumping and running. However, PFPS can also occur in non-athletes. Symptoms usually involve a dull, aching pain in the front of the knee. The severe pain and stiffness caused by this condition can make it extremely difficult to kneel down, sit for long periods, climb stairs, squat and perform other day-to-day activities. The exact factors that cause the pain condition are not known. However, a combination of factors like – muscle imbalances or weaknesses, overuse (from vigorous athletics or training), problems with the alignment of the kneecap, and knee surgeries may contribute to the development of the condition. Treatment for this condition usually begins with simple measures like resting the knee as much as possible and icing the knee area. Medications, physical therapy exercises, and supportive braces may also be recommended. In severe cases, if non-surgical treatments are not effective, physicians may advise surgical and other procedures like – arthroscopy and realignment (realigning the angle of the knee cap or relieve pressure from the cartilage). ICD-10 codes for a PFPS diagnosis include –

  • 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 TendinitisPatellar tendinitis is an injury or inflammation to the tendon that connects the kneecap (patella) to your shinbone (tibia). The patellar tendon works with the muscles at the front of your thigh to extend your knee and make it possible for people to kick, run and jump. Also known as jumper’s knee, the condition is more common among athletes whose sports activities involve frequent jumping such as basketball and volley ball. People who do not involve in these sports activities can also experience this condition. Reports suggest that an estimated 40 to 50 of elite volleyball players have jumper’s knee. The condition occurs from repetitive stress on the knees, most often from overuse in sports or exercise. The repetitive stress on the knees may create tiny tears in the tendon which may in course inflame and weaken the tendons. Pain and tenderness at the base of the kneecap are one of the initial symptoms associated with the condition. In some cases, people may also experience swelling and a burning feeling in the kneecap. The pain may initially be irregular, occurring only after sports or exercise activity. As the tendon becomes more damaged, the pain can become progressively worse. Physicians may physically examine the knee, probe for the specific area of pain, and test the range of knee motion by bending and extending the leg. Imaging tests like X-Ray, MRI and Ultrasound may be performed to determine the severity of damage to the tendon or bone. Treatment for this condition depends on the extent and severity of the injury. Conservative measures like over-the-counter (OTC) drugs, physical therapy and injections will be the first line of treatment. Physicians will usually advise a period of controlled rest, where patients need to avoid activities that puts force on the knee. Surgery to repair the patellar tendon may also be considered if the conservative measures do not give in the desired results. Related ICD-10 codes include –

  • 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

    For mild or moderate injuries, basic self-care techniques like rest, icing and compression can help. Rest is essential, as you cannot stress the injured knee as it heals. Over-the-counter medications can help with reducing pain and inflammation. Compressing your knee with braces, sleeves, straps, or elastic bandages can provide adequate support while also reducing swelling, thereby promoting faster healing.

    Billing and coding for different types of overuse knee injuries can be complex, as there are different codes associated with each specific condition. By outsourcing these tasks to a reliable medical billing service provider that offers the service of AAPC-certified coding specialists, healthcare practices can ensure accurate and timely medical billing and claims submission.

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