ICD Code M17.11

ICD code M17.11 is used to identify unilateral primary osteoarthritis affecting the right knee. This code specifies that the osteoarthritis, a degenerative joint disease characterized by the breakdown of joint cartilage and underlying bone, is present in only one knee, specifically the right one, and is not secondary to any other condition or injury.

1. Unilateral Joint Involvement: The condition must affect only one knee, specifically the right knee, without any involvement of the left knee.

2. Primary Osteoarthritis: The diagnosis should be for primary osteoarthritis, meaning it is not secondary to any other condition or injury. It should be a degenerative joint disease that occurs naturally with age or wear and tear.

3. Chronic Joint Pain: The patient should experience persistent pain in the right knee, which may worsen with activity and improve with rest.

4. Stiffness: There should be noticeable stiffness in the right knee, particularly after periods of inactivity or in the morning, lasting for a short duration.

5. Swelling: The presence of swelling in the right knee due to inflammation or excess fluid in the joint should be observed.

6. Reduced Range of Motion: The patient should exhibit a decreased ability to move the right knee through its full range of motion.

7. Crepitus: There may be a sensation or sound of grating, crackling, or popping when the right knee is moved.

8. Radiographic Evidence: Imaging studies, such as X-rays, should show characteristic changes of osteoarthritis in the right knee, including joint space narrowing, osteophyte formation, and subchondral sclerosis.

9. Exclusion of Other Conditions: Other potential causes of knee pain and dysfunction, such as rheumatoid arthritis, gout, or knee injuries, should be ruled out through clinical evaluation and diagnostic testing.

For the ICD code M17.11, which pertains to unilateral primary osteoarthritis of the right knee, the relevant CPT codes that may be applicable for treatment include:

1. 20610 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa (e.g., knee joint, subacromial bursa); without ultrasound guidance.

2. 20611 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa (e.g., knee joint, subacromial bursa); with ultrasound guidance.

3. 29870 - Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure).

4. 29871 - Arthroscopy, knee, surgical; for infection, lavage, and drainage.

5. 29881 - Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving).

6. 29888 - Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction.

7. 27447 - Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty).

8. 27446 - Arthroplasty, knee, condyle and plateau; medial OR lateral compartment (unicompartmental knee arthroplasty).

These CPT codes are commonly associated with procedures that may be performed to treat conditions related to the ICD code M17.11. It is important for healthcare providers to select the appropriate CPT code based on the specific treatment or procedure performed.

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments for CPT codes associated with ICD code M17.11. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.