ICD 10 CODE FOR Knee Pain
ICD-9-CM for Knee Pain is 719.46. Convert to ICD-10-CM is M25.569 Pain in unspecified knee. Arthralgia (joint pain) of lower leg.
M25.561 – Pain in right knee
M25.562 – Pain in left knee
M25.569 – Pain in unspecified knee
M25.56 Pain in knee
Osteoarthritis of the Knee (ICD-9-CM 715.16, 715.26, 715.36, 715.96)
M17.0 Bilateral primary osteoarthritis of knee
M17.10* Unilateral primary osteoarthritis, unspecified knee
M17.11 Unilateral primary osteoarthritis, right knee
M17.12 Unilateral primary osteoarthritis, left knee
M17.2 Bilateral post-traumatic osteoarthritis of knee
M17.30* Unilateral post-traumatic osteoarthritis, unspecified knee
M17.31 Unilateral post-traumatic osteoarthritis, right knee
M17.32 Unilateral post-traumatic osteoarthritis, left knee
M17.4 Other bilateral secondary osteoarthritis of knee
M17.5 Other unilateral secondary osteoarthritis of knee
M17.9* Osteoarthritis of knee, unspecified
ICD-9 Code ICD-9 Description ICD-10 Code ICD-10 Description
719.46 Pain in joint, lower leg
M25.561 Pain in right knee
M25.562 Pain in left knee
M25.569 Pain in unspecified knee
ICD 9 Code for Knee Pain
Osteoarthritis of the Knee (ICD-9-CM 715.16, 715.26, 715.36, 715.96)
M17.0 Bilateral primary osteoarthritis of knee
M17.10* Unilateral primary osteoarthritis, unspecified knee
M17.11 Unilateral primary osteoarthritis, right knee
M17.12 Unilateral primary osteoarthritis, left knee
M17.2 Bilateral post-traumatic osteoarthritis of knee
M17.30* Unilateral post-traumatic osteoarthritis, unspecified knee
M17.31 Unilateral post-traumatic osteoarthritis, right knee
M17.32 Unilateral post-traumatic osteoarthritis, left knee
M17.4 Other bilateral secondary osteoarthritis of knee
M17.5 Other unilateral secondary osteoarthritis of knee
M17.9* Osteoarthritis of knee, unspecified
* Codes with a greater degree of specificity should be considered first.
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ICD 10 CODE FOR Abdominal Pain
ICD 9 Code for Abdominal Pain is 789.0, which Converts to ICD -10 R10.9 Unspecified abdominal pain.
R10.10 – Upper abdominal pain, unspecified
R10.30 – Lower abdominal pain, unspecified
R10.84 – Generalized abdominal pain
R10.9 – Unspecified abdominal pain
Common ICD 10 CODE for Signs and symptoms of Abdominal pain
Generalized (not severe) R10.84
Acute (severe) R10.10
Right upper quadrant pain R10.11
Left upper quadrant pain R10.12
Epigastric pain R10.13
Right lower quadrant pain R10.31
Left lower quadrant pain R10.32
Periumbilical pain R10.33
ICD 9 for Abdominal Pain
Approximate Synonyms
Abdominal colic in adult or child greather than 12 months
Abdominal colic, adult or child > 12 months old
Abdominal pain
Abdominal pain, acute
Abdominal pain, chronic
Abdominal pain, recurrent
Abdominal pain, visceral
Acute abdomen
Acute abdominal pain
Acute exacerbation of chronic abdominal pain
Adult colic
Chronic abdominal pain
Chronic abdominal pain w acute exacerbation
Chronic abdominal pain with acute exacerbation
Colic in adult
Recurrent abdominal pain
Visceral abdominal pain
Visceral pain
ICD-9 Code Diagnoses ICD-10 Code
789 Abdominal pain NOS R10.9
PREFABRICATED KNEE ORTHOSES (L1810, L1820, L1830 – L1832, L1836, L1843, L1845, L1847, L1850):
A KNEE flexion contracture is a condition in which there is shortening of the muscles and/or tendons with the resulting inability to bring the KNEE to 0 degrees extension or greater (i.e., hyperextension) by passive range of motion. (0 degrees KNEE extension is when the femur and tibia are in alignment in a horizontal plane). A KNEE extension contracture is a condition in which there is shortening of the muscles and/or tendons with the resulting inability to bring the KNEE to 80 degrees flexion or greater by passive range of motion. A contracture is distinguished from the temporary loss of range of motion of a joint following injury, surgery, casting, or other immobilization
A KNEE orthosis with joints (L1810) or KNEE orthosis with condylar pads and joints with or without patellar control (L1820) are covered for ambulatory beneficiaries who have weakness or deformity of the KNEE and require stabilization.
if an L1810 or L1820 is provided but the criteria above are not met, the orthosis will be denied as not
reasonable and necessary.
A KNEE orthosis with a locking KNEE joint (L1831) or a rigid KNEE orthosis (L1836) is covered for beneficiaries with flexion or extension contractures of the KNEE (ICD-9 diagnosis code 718.46) with movement on passive range of motion testing of at least 10 degrees (i.e., a nonfixed contracture).
If an L1831 or L1836 orthosis is provided but the criterion above is not met, the orthosis will be denied as not reasonable and necessary.
There is no proven clinical benefit to the inflatable air bladder incorporated into the design of code L1847; therefore, claims for code L1847 will be denied as not reasonable and necessary.
KNEE ORTHOSES L1832, L1843 and L1845 are also covered for a beneficiary who is ambulatory and has KNEE instability due to a condition specified in any diagnosis listed above; or one of the following diagnoses:
Diagnosis ICD-9
Multiple sclerosis 340
Hemiplegia, unspecified; dominant side; nondominant side 342.90, 342.91, 342.92
Infantile cerebral palsy, unspecified 343.9
Paraplegia of both lower limbs 344.1
Mononeuritis of lower limb, unspecified 355.0, 355.2
For codes L1832, L1843, L1845 and L1850, KNEE instability must be documented by examination of the beneficiary and objective description of joint laxity (e.g., varus/valgus instability, anterior/posterior Drawer test).
Claims for L1832, L1843, L1845 or L1850 will be denied as not reasonable and necessary when the beneficiary does not meet the above criteria for coverage. For example, they will be denied if only pain or a subjective description of joint instability is documented.
“Addition” codes are grouped into four (4) categories in relation to KNEE orthosis base codes.
• Eligible for separate payment
• Not reasonable and necessary
• Not separately payable
• Incompatible
The following table lists addition codes which describe components or features that can be and frequently are physically incorporated in the specified prefabricated base orthosis. Addition codes may be separately payable if:
• They are provided with the related base code orthosis; and
• The base orthosis is reasonable and necessary; and
• The addition is reasonable and necessary
Addition codes will be denied as not reasonable and necessary if the base orthosis is not reasonable and necessary or the addition is not reasonable and necessary.
Base Code Addition Codes – Eligible for Separate Payment
L1810 None
L1820 None
L1830 None
L1831 None
L1832 L2397, L2795, L2810
L1836 None
L1843 L2385, L2395, L2397
L1845 L2385, L2395, L2397, L2795
L1847 None
L1850 L2397
CUSTOM FABRICATED KNEE ORTHOSES (L1834, L1840, L1844, L1846, L1860):
A custom fabricated orthosis is covered when there is a documented physical characteristic which requires the use of a custom fabricated orthosis instead of a prefabricated orthosis. Examples of situations which meet the criterion for a custom fabricated orthosis include, but are not limited to:
1. Deformity of the leg or KNEE;
2. Size of thigh and calf;
3. Minimal muscle mass upon which to suspend an orthosis.
Although these are examples of potential situations where a custom fabricated orthosis may be appropriate, suppliers must consider prefabricated alternatives such as pediatric KNEE ORTHOSES in patients with small limbs, straps with additional length for large limbs, etc.
If a custom fabricated orthosis is provided but the medical record does not document why that item is medically necessary instead of a prefabricated orthosis, the custom fabricated orthosis will be denied as not reasonable and necessary.
Custom fabricated ORTHOSES (L1834, L1840, L1844, L1846, L1860) are not reasonable and necessary in the treatment of KNEE contractures in cases where the patient is nonambulatory.
A custom fabricated KNEE immobilizer without joints (L1834) is covered if criteria 1 and 2 are met:
1. The coverage criteria for the prefabricated orthosis code L1830 are met; and
2. The general criterion for a custom fabricated orthosis is met.
If an L1834 orthosis is provided and both criteria 1 and 2 are not met, the orthosis will be denied as not reasonable and necessary
A custom fabricated derotation KNEE orthosis (L1840) is covered for instability due to internal ligamentous disruption of the KNEE (717.81–717.9).
1. The coverage criteria for the prefabricated orthosis codes L1843 and L1845 are met; and
2. The general criterion for a custom fabricated orthosis is met.
If an L1844 or L1846 orthosis is provided and both criteria 1 & 2 are not met, the orthosis will be denied as not reasonable and necessary.
A custom fabricated KNEE orthosis with a modified supracondylar prosthetic socket (L1860) is covered for a patient who is ambulatory and has KNEE instability due to genu recurvatum – hyperextended KNEE (736.5).
The following table lists addition codes which describe components or features that can be and frequently are physically incorporated in the specified custom fabricated base orthosis. Addition codes may be separately payable if:
• They are provided with the related base code orthosis; and
• The base orthosis is reasonable and necessary; and
• The addition is reasonable and necessary.
Addition codes will be denied as not reasonable and necessary if the base orthosis is not reasonable and necessary or the addition is not reasonable and necessary.
Base Code Addition Codes – Eligible for Separate Payment
L1834 L2795
L1840 L2385, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2755,
L2785, L2795
L1844 L2385, L2390, L2395, L2397, L2405, L2492, L2755, L2785
L1846 L2385, L2390, L2395, L2397, L2405, L2415, L2492, L2755, L2785, L2795,
L2800
L1860 None
The following table lists addition codes which describe components or features that can be physically incorporated in the specified custom fabricated base orthosis but are considered not reasonable and necessary. These addition codes, if they are billed with the related base code, will be denied as not reasonable and necessary.
Base Code Addition Codes – Not Reasonable and Necessary
L1834 L2397, L2800
L1840 L2275, L2800
L1844 None
L1846 None
L1860 L2397
Heavy duty KNEE joint codes (L2385, L2395) are covered only for patients who weigh more than 300 pounds.
Coverage of a removable soft interface (K0672) is limited to a maximum of two (2) per year beginning one (1) year after the date of service for initial issuance of the orthosis. Additional replacement interfaces will be denied as not reasonable and necessary. Refer to the Coding Guidelines section of the related Policy Article for information on denial of removable soft interfaces that are billed separately at the time of initial issue of the orthosis
Concentric adjustable torsion style mechanisms used to assist KNEE joint extension are coded as L2999 and are covered for beneficiaries who require KNEE extension assist in the absence of any co-existing
joint contracture.
