# Chondromalacia



## farmgirl1959 (Dec 31, 2015)

When i code chondromalacia of the patella and other sites of the right knee, i get an edit that i cannot code m22.41 at the same time as m94.261.  Which code do i delete when both are present?


----------



## mitchellde (Dec 31, 2015)

If you have chondromalacia of more than just the patella then code M94.621 will include the patella.


----------



## farmgirl1959 (Dec 31, 2015)

Thank you so much


----------



## slrogers63 (Feb 18, 2016)

Where can I find that in writing?


----------



## CodingKing (Feb 18, 2016)

slrogers63 said:


> Where can I find that in writing?



ICD Book has it in writing. Follow the index. chondromalacia > Knee. M94.2- has an excludes 1 note for patella which means you cant code knee and patella together. If it's only the patella then you can report the M22.40.


----------



## slrogers63 (Feb 18, 2016)

Thank you so much!  That was my thinking.  I received my audit and the auditor states I should code both together.


----------



## AlanPechacek (Feb 21, 2016)

M22.4 _ is specific to Chondromalacia to the Patella, and only the Patella, and does not include any other Chondromalacia that may exist in the same joint.  M94.26 _ applies to Chondromalacia of the Knee Joint other than the Patella (Exclusion1 Note).  If the Knee Joint in question has both Chondromalacia of the Patella and Chondromalacia of other areas of the joint (Femoral Trochlea, Medial &/or Lateral Femoral Condyles &/or Medial &/or Tibial Plateaus), then I would recommend reporting both, particularly if there is an operative procedure that includes Chondroplasty of more than one of these joint areas.

Respectfully submitted, Alan Pechacek, M.D.


----------



## CodingKing (Feb 21, 2016)

AlanPechacek said:


> M22.4 _ is specific to Chondromalacia to he Patella, and only the Patella, and does not include any other Chondromalacia that may exist in the same joint.  M94.26 _ applies to Chondromalacia of the Knee Joint other than the Patella (Exclusion1 Note).  If the Knee Joint in question has both Chondromalacia of the Patella and Chondromalacia of other areas of the joint (Femoral Trochlea, Medial &/or Lateral Femoral Condyles &/or Medial &/or Tibial Plateaus), then I would recommend reporting both, particularly if there is an operative procedure that includes Chondroplasty of more than one of these joint areas.
> 
> Respectfully submitted, Alan Pechacek, M.D.



I haven't seen anything stating you an ignore an excludes1 note. I would think if they wanted it coded separately they would have added an Excludes2 and not Excludes 1.


----------



## AlanPechacek (Feb 22, 2016)

This certainly creates a dilemma:  Chondromalacia of the Patella (M22) is in the Code Set for Patellar Disorders, and therefore would be specific to the patella and not inclusive of Chondromalacia elsewhere in the joint.  The M94.26 _ Code Set includes Chondromalacia of the Knee Joint, but not Chondromalacia of the Patella.  In spite of the Excludes 1 for M94.2, if the patient has both, and particularly if both are addressed at surgery, then I would still code both.  The Excludes 1 for M94.2 should probably be an Excludes 2 Note, but the CMS will have to figure that out and solve the dilemma.

Alan Pechacek, M.D.


----------



## mhstrauss (Feb 24, 2016)

It took me a little while to find this, but I remembered coming across it before, so I wanted to include it in the "ignoring the Excludes 1 notes" issue.

The WHO has an FAQ regarding this...that, at times, it may be appropriate to use to 2 codes together even though there is an excludes 1 note for the pair. My understanding is that this info will be included in future book updates.

http://www.cdc.gov/nchs/data/icd/Interim_advice_updated_final.pdf


***I'm not saying that this applies to the OP's original questions, as I'm not familiar with those codes; just wanted to give this info for the excludes notes.

HTH!


----------



## doctor.ryan.monson@sbcglobal.net (Mar 27, 2019)

mhstrauss said:


> It took me a little while to find this, but I remembered coming across it before, so I wanted to include it in the "ignoring the Excludes 1 notes" issue.
> 
> The WHO has an FAQ regarding this...that, at times, it may be appropriate to use to 2 codes together even though there is an excludes 1 note for the pair. My understanding is that this info will be included in future book updates.
> 
> ...



Yes, I just learned this recently  myself.  If you read onto the second paragraph in the guideline for the Excludes 1 Note in the ICD-10-CM Guidelines Section I/A/12/a, it says, "An exception to the Excludes 1 definition is the circumstance when the two conditions are unrelated to each other..."  Learning this has made knee coding a lot easier because there are a lot of knee codes that have excludes 1 notes with each other, but you have them on different structures in the knee all the time, such as meniscus derangement and condyle derangement, or derangement and injuries in different compartments, and so on.  The Excludes 1 is just to stop us from using multiple codes on the same structure instead of figuring out which one is right, but we need to code all the lesions that are in there.


----------

