ASC Coding Education: Knee Diagnoses & Procedures

Choose this ICD-9 code if you see ‘jumper’s knee’ in the orthopedic surgeon’s note.

Here’s a handy introduction to common ICD-9 codes related to the knee, along with examples of CPT codes for procedures physicians perform to treat knee diagnoses.

Chondromalacia Patella

Chondromalacia patella (717.7) is also known as “patellofemoral syndrome” or “runner’s knee.” This condition results when the cartilage under the patient’s patella becomes damaged and causes pain particularly when the patient climbs stairs or bends his knee.

This is a common condition among runners or other athletes who jump, squat or climb. But chondromalacia patella can also be associated with arthritis, so the condition affects patients in all age groups.

When NSAIDs, physical therapy and rest do not alleviate the patient’s symptoms, the surgeon may opt to perform arthroscopic lateral release (29873) or chondroplasty (27425) to repair the damage.

Iliotibial Band Syndrome

When a patient’s distal iliotibial band causes an excessive amount of friction as it slides over the lateral femoral epicondyle during knee extension, the patient may suffer from iliotibial band syndrome (728.89). This condition, which usually affects athletes such as runners and cyclists, is characterized by pain localized over the lateral femoral epicondyle that occurs during vigorous knee movement.

When conservative treatments are ineffective, the surgeon may perform surgery, such as an iliotibial band release (27305).

Ligament Injuries

The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) connect the femur to the tibia. These ligaments are inside the knee joint. The ACL controls rotation and forward movement of the femur, and the PCL controls backward movement of the tibia.

The medial collateral ligament (MCL) provides stability to the inside of the knee, and the lateral collateral ligament (LCL) stabilizes the knee’s outer side.

For an ACL injury, the surgeon will usually perform an arthroscopic ACL repair (29888) or thermal shrinkage (29999). You will probably rely on 29889 for an arthroscopic PCL repair.

If the physician treats a collateral ligament injury, the surgeon may repair or reconstruct the ligament as an open procedure (27405, 27427, 27429).

Meniscal Tears

Many coders are usually very familiar with meniscal tears because this is a common injury involving torn cartilage at the knee. You will see documentation that the patient has torn one of two knee menisci: the medial meniscus (836.0), located on the inside of the knee, and/or the lateral meniscus (836.1), located on the outside of the knee. These menisci serve as shock absorbers for the knee, but are easily torn as a result of wear-and-tear by athletes. Patients also may tear the menisci as a result of trauma, such as squatting or twisting the knee. Meniscus tears can also be degenerative, especially in the older population (717.0, 717.49).

Patients usually present with pain, swelling and occasionally locking of the knee. The surgeon will confirm the diagnosis using an MRI and will usually prescribe rest, anti-inflammatories or physical therapy.

If these conservative therapies fail, the surgeon will usually perform an arthroscopic meniscectomy or meniscus repair (29880, 29883) or a meniscal transplant (29868).

Osteochondritis Dissecans

Osteochondritis dissecans (732.7) occurs when the femoral condyles and the adjacent cartilage lose blood flow. This causes part of the bone to die and produce a lesion or multiple lesions that cause pain and swelling.

If the lesion does not heal or becomes detached, the surgeon may perform arthroscopic surgery (29874, 29885, 29887) or autologous chondrocyte implantation (27412) to heal the injury.

Tendonitis/Bursitis

Knee inflammation is often caused by tendonitis or bursitis (726.60, 726.69) of the knee.

If the tendons in the knee become inflamed, the patient may be suffering from tendonitis, most commonly in the patellar tendon. Your physicians may also refer to patellar tendonitis (726.64) as “jumper’s knee” because it can be caused by excessive squatting and jumping.

If the knee’s bursa becomes inflamed, the patient may have knee bursitis, usually in the bursa that lies on the patella. This condition is called “prepatellar bursitis” (726.65).

Physicians usually prescribe rest and avoidance of the activity that led to the bursitis or tendonitis, along with NSAIDs and possibly injections for tendonitis (such as 20550) or arthrocentesis for bursitis (such as 20610). Physicians don’t often perform surgery to treat these conditions.

ASC Coders: Toughen up your knee and shoulder coding with Cristina Bentin in Orlando, December 6-8.

Orthopedic Coders: Prepare for your COSC™ specialty coding credential exam. Coming to a city near you.

Related articles:

1. Orthopedic Coding Quick Start Guide: ASC Shoulder ProceduresShoulder ICD-9 and CPT codes you’ll most likely see in…
2. Test Yourself: Total Knee Replacement (TKR) Coding Can you tackle an op note like this one…
3. Anesthesia Coding Education: Sciatic Nerve Block & Same-Day General AnesthesiaQuestion: My anesthesiologist performed a sciatic nerve block for a…