Knee pain is one of the most common musculoskeletal conditions treated by physical therapists. Whether it stems from a sports injury, arthritis, or overuse, accurate documentation is essential for both effective care and compliant billing. Choosing the correct ICD-10 code for knee pain ensures that your claims are processed smoothly and your clinic stays audit-ready.
This guide walks you through how to correctly use knee pain ICD-10 codes, avoid common errors, and streamline your documentation process.
What Is the ICD-10 Code for Knee Pain?
Here’s the breakdown:
| ICD-10 Code | Description |
|---|---|
| M25.561 | Pain in right knee |
| M25.562 | Pain in left knee |
| M25.569 | Pain in unspecified knee |
When to Use Each Knee Pain Code
Use this when the patient clearly reports pain in the right knee.
Related keyword: ICD 10 code for right knee pain
Use when pain is documented in the left knee.
Related keyword: ICD 10 code for left knee pain
For patients with pain in both knees, report both codes. There’s no single bilateral knee pain ICD-10 code.
Related keyword: bilateral knee pain ICD 10
Use only when documentation does not specify the side. This should be a last resort.
Related keyword: ICD 10 code knee pain
Why Accurate ICD-10 Coding Matters
Documentation Tips for Physical Therapists
Quick ICD-10 Knee Pain Reference Table
| Condition | Correct Code(s) | Notes |
|---|---|---|
| Right knee pain | M25.561 | Must be clearly documented |
| Left knee pain | M25.562 | Same as above |
| Bilateral knee pain | M25.561 + M25.562 | Use both codes |
| Unspecified knee pain | M25.569 | Use only if side not known |
| General joint pain | M25.5 (parent code) | Not billable—use specific subcode |
How to Streamline Knee Pain ICD-10 Coding
Beyond Knee Pain: Related ICD-10 Codes for PT Evaluations
| Condition | ICD-10 Code(s) | Notes |
|---|---|---|
| Osteoarthritis of knee | M17.0–M17.9 | Use laterality-specific codes |
| Meniscus tear (traumatic) | S83.2– | Include external cause codes if relevant |
| Patellofemoral pain syndrome | M22.2– | Common in athletic patients |
| Chondromalacia patellae | M22.4 | Often seen in younger adults |
ICD-10 Coding Success Across the Care Team
Final Takeaway
By specifying laterality, updating your documentation process, and training your team regularly, you can make ICD-10 coding truly painless.
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Knee pain is categorized under the musculoskeletal section of ICD-10, specifically in subcategory M25.56 – Pain in joint, knee.
These are the three primary codes used in physical therapy for documenting knee pain.
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Right Knee Pain – M25.561
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Left Knee Pain – M25.562
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Bilateral Knee Pain – Use Both M25.561 and M25.562
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Unspecified Knee Pain – M25.569
Precise ICD-10 coding affects both reimbursement and compliance. Inaccurate or unspecified coding can lead to:
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Claim denials or payment delays
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Compliance risks and potential audits
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Incomplete data for clinical tracking and outcomes
Correct coding ensures clear documentation and smoother billing operations.
✅ Best Practices
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Always specify laterality (e.g., “left knee pain when descending stairs”).
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For bilateral pain, describe symptoms for each knee individually.
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Avoid assumptions—confirm with the patient which side hurts.
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Use M25.569 only when laterality is truly unknown.
❌ Common Mistakes
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Using unspecified codes as the default option
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Failing to record laterality in notes
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Ignoring annual ICD-10 code updates
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Assuming “bilateral” means one code—it doesn’t
Implementing a few smart systems can make ICD-10 coding faster and more accurate:
🧩 Recommended Tools and Processes
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Use EMR templates with left/right checkboxes
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Set up alerts for incomplete or unspecified codes
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Provide annual ICD-10 training for staff
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Preload common PT scenarios (e.g., post-op ACL rehab, OA management) into your software
Sometimes, knee pain is just a symptom of an underlying condition. Physical therapists should know when to code for a specific diagnosis rather than general joint pain.
Shifting from general pain codes (M25.56) to more specific diagnoses enhances clinical accuracy and supports medical necessity for ongoing treatment.
Consistent accuracy requires a team effort across your clinic.
👥 Team-Based Strategies
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Front desk staff: Confirm referral documentation includes laterality.
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Therapists: Record detailed notes about pain location and mechanism.
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Billing staff: Verify documentation before claim submission.
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Practice managers: Monitor denial trends and schedule coding refreshers.
With clear workflows and shared accountability, your clinic can maintain compliance, minimize denials, and improve revenue cycle efficiency.
Using the correct ICD-10 codes for knee pain—M25.561, M25.562, and M25.569—isn’t just about coding accuracy. It’s about ensuring clinical clarity, payer compliance, and smooth reimbursement.
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