M25.069 — Hemarthrosis, unspecified knee
Is M25.069 billable?
Yes, but M25.069 will trip a Medicare edit. M25.069 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists M25.069 under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
More specific alternatives
M25.069 at a glance
| Code | M25.069 |
|---|---|
| Description | Hemarthrosis, unspecified knee |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to M25.069?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name M25.069 directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does M25.069 group to?
M25.069 sits in MDC 08 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 553Bone Diseases and Arthropathies with MCCmedical
- 554Bone Diseases and Arthropathies without MCCmedical
As a secondary diagnosis, M25.069 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is M25.069 listed in the Alphabetic Index?
The Alphabetic Index lists these routes under M25.06, the nearest indexed parent of M25.069. Use them to find the family, then select the specific code.
- Hemarthrosis › knee (nontraumatic)
Excludes1 — never code together — inherited from M25.0
The conditions below can never be reported together with M25.069 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- current injury - see injury of joint by body region
- hemophilic arthropathy (M36.2)
Excludes2 — not included here — inherited from Chapter 13
The conditions below are not part of M25.069, but a patient may have both at the same time. When documentation supports it, M25.069 and the excluded code may both be reported.
- arthropathic psoriasis (L40.5-)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- compartment syndrome (traumatic) (T79.A-)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Excludes2 — not included here — inherited from M20-M25
The conditions below are not part of M25.069, but a patient may have both at the same time. When documentation supports it, M25.069 and the excluded code may both be reported.
- joints of the spine (M40-M54)
Excludes2 — not included here — inherited from M25
The conditions below are not part of M25.069, but a patient may have both at the same time. When documentation supports it, M25.069 and the excluded code may both be reported.
How long has M25.069 existed?
M25.069 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.