Documenting and Coding Chondromalacia Patellae – A Common Knee Pain Condition

by | Jan 16, 2020 | Resources | 0 comments

Chondromalacia patellae (CMP), refers to the progressive erosion of the articular cartilage of the knee joint. The condition occurs when the cartilage on the under surface of the patella (kneecap) deteriorates and softens. Also known as patello-femoral pain syndrome or patello-femoral stress syndrome, this condition causes pain or discomfort at the front of the knee. The patella is the moveable bone on the knee cap. Poor alignment of the kneecap (patella) (as it slides over the lower end of the thigh bone) causes chondromalacia patella or patellofemoral syndrome. The condition is common among young, athletic individuals, but may also occur in older adults who have arthritis of the knee. Treatment modalities for this condition aim to reduce the pressure on the kneecap and joint. Resting, stabilizing, and icing the joint may be the first line of treatment. Using the right medical codes for documenting the symptoms, diagnosis and treatment of this sports injury is crucial for accurate processing of medical claims. Outsourcing billing tasks to a reliable medical billing and coding company can help physical therapists, orthopedic surgeons, sports medicine specialists and other physicians submit their medical claims without errors.

This painful condition occurs due to repetitive wear and tear of the kneecap (due to acute injury to the patella or due to aging). When you bend the knee, the backside of the kneecap glides over the cartilage of the femur, or thigh bone, at the knee. Tendons and ligaments attach the kneecap to the shinbone and thigh muscle. When any of these components fails to move properly, it can cause the kneecap to rub against the thigh bone. This abnormal rubbing can lead to deterioration in the patella, resulting in chondromalacia patellae.

Improper kneecap movement may often result from –

  • Poor alignment due to a congenital condition
  • Weak hamstrings and quadriceps
  • Repeated stress to the knee joints, such as from running, skiing, or jumping
  • Muscle imbalance between the adductors and abductors
  • A direct blow or trauma to the kneecap

Symptoms of CMP

Chronic pain (normally around the knee cap) and a grinding sensation felt when extending the leg are the initial symptoms of the condition. The pain may radiate towards the back of the knee or it may be intermittent and brought on by squatting, kneeling, going up or down the stairs, especially down; or by repeated bending of the joint.

How to Diagnose and Treat CMP

Diagnosis of patello-femoral pain syndrome may normally begin with a physical examination and a detailed review of previous medical history and symptoms. Physicians will look for areas of swelling or tenderness in the knee. They may also look at how the kneecap aligns with the thigh bone. Physician may also apply resistive pressure to the extended kneecap to determine the tenderness and severity. Diagnostic imaging tests like X-ray and knee MRI may be recommended to determine if the patella is properly aligned and to evaluate the soft tissues within the area. In addition, an arthroscopic exam – which involves inserting an endoscope and camera into the knee joint – will be conducted to visualize the inside of the knee.

Treatment for this condition aims to reduce the pressure on the kneecap and joint. Resting, stabilizing, and icing the joint may be the initial line of treatment. Physical therapy may be recommended to strengthen the quadriceps, hamstrings, and abductors in order to improve the patient’s muscle strength and balance. In addition, anti-inflammatory medications (like ibuprofen) may be prescribed to reduce inflammation around the joint. In severe cases, arthroscopic surgery may be essential to examine the joint and determine whether there’s misalignment of the knee. Other surgical options are smoothing the back of the kneecap, implanting a cartilage graft, or relocating the insertion of the thigh muscle.

Orthopedic medical billing and coding is quite challenging. The causes, symptoms, diagnosis and treatment procedures offered by orthopedists and other pain management specialists must be documented using the correct medical codes. Billing and coding services offered by reliable medical billing companies can help physicians use the correct medical codes for their billing purposes. The following ICD-10 codes are used for billing procedures –

  • 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 knee
    • M22.91 – Unspecified disorder of patella, right knee
    • M22.92 – Unspecified disorder of patella, left knee

Maintaining a healthy body weight can help take pressure off the knees and other joints. Proper exercises are one of the best preventive measures. Strengthening exercises (such as short arc leg extensions, straight leg raises, quadriceps isometric exercises, and stationary bicycling) can increase the flexibility of the knee muscles.

Medical billing and coding for patella injuries can be complex, as there are different codes associated with the condition. By outsourcing these tasks to a reliable medical billing service provider that offers the services of AAPC-certified coding specialists, healthcare practices and providers can ensure correct and timely medical billing and claims submission.

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