Billable FY2026 ICD-10-CM diagnosis code, knee region. What it covers, how to bill it cleanly, and what these patients sound like when they call.
Pain in the right knee, a symptom code used when a definitive structural diagnosis has not been established. Legitimate at first presentation, before imaging, or when pain is the honest extent of what is known. Once a structural diagnosis is confirmed, coding should graduate to it.
| Code | Description |
|---|---|
| M25.562 | Pain in left knee |
| M25.569 | Pain in unspecified knee |
| M25.461 | Effusion, right knee |
| M25.462 | Effusion, left knee |
| M25.469 | Effusion, unspecified knee |
| M25.511 | Pain in right shoulder |
This is the classic new-patient call: a knee that hurts, no imaging yet, no diagnosis. The scheduling decision is which knee specialist sees them and how soon, and the intake questions that matter are mechanism, swelling, instability, and weight-bearing status, exactly what a well-run phone screening captures.
ClinicFlow's voice AI runs this intake on every call for joint replacement practices: capturing the story, applying your routing rules, and booking the right visit type with the right surgeon. See voice AI for joint replacement practices or the Call Library for how each call type is handled.
M25.561 is the FY2026 ICD-10-CM code for pain in right knee. Pain in the right knee, a symptom code used when a definitive structural diagnosis has not been established.
It is a signal problem. Symptom codes at the first visit are normal; the same symptom code at visit 4 suggests the documented diagnosis has not caught up with the clinical reality, and payers notice.
Yes. M25.561 appears in the official FY2026 ICD-10-CM code set (effective October 1, 2025). ICD-10-CM is public-domain CMS data; verify annually as codes are revised each fiscal year.
ClinicFlow answers all of them, 24/7, and books them with the right surgeon.
