Orthopedics ICD-10 Codes & CPT Codes

Orthopedic coding requires precise laterality, fracture type, and episode-of-care detail. This page covers the most frequently used ICD-10-CM and CPT codes for orthopedic surgeons, sports medicine physicians, and musculoskeletal specialists practicing in the United States.

FY 2026 ICD-10-CM (CMS) · CPT codes updated annually · All codes verified billable · Last verified: June 2026

🔍 Search Codes on This Page


Top ICD-10 Codes for Orthopedics

ICD-10 Code Description Billable
M17.11 Primary osteoarthritis, right knee ✓
M17.12 Primary osteoarthritis, left knee ✓
M16.11 Primary osteoarthritis, right hip ✓
M54.5 Low back pain ✓
M75.100 Unspecified rotator cuff tear or rupture of right shoulder ✓
M25.511 Pain in right shoulder ✓
M23.200 Derangement of unspecified meniscus due to old tear or injury, right knee ✓
M47.816 Spondylosis with radiculopathy, lumbar region ✓
M51.16 Intervertebral disc degeneration, lumbar region ✓
M54.4 Lumbago with sciatica, unspecified side ✓
M48.06 Spinal stenosis, lumbar region ✓
S72.001A Fracture of unspecified part of neck of right femur, initial encounter ✓
M20.10 Hallux valgus (acquired), unspecified foot ✓
M65.312 Trigger finger, left index finger ✓
M25.561 Pain in right knee ✓
M75.30 Calcific tendinitis of unspecified shoulder ✓
M54.2 Cervicalgia ✓
M77.10 Lateral epicondylitis, unspecified elbow (Tennis elbow) ✓
M19.90 Unspecified osteoarthritis, unspecified site ✓
M81.0 Age-related osteoporosis without current pathological fracture ✓
M50.20 Cervical disc displacement, unspecified cervical region ✓
M21.611 Bunion of right foot ✓
M21.621 Bunionette of right foot ✓
M72.0 Palmar fascial fibromatosis (Dupuytren) ✓
M72.2 Plantar fascial fibromatosis ✓
M79.621 Pain in right upper arm ✓
M79.622 Pain in left upper arm ✓
M79.3 Panniculitis, unspecified ✓
M84.311 Stress fracture, right shoulder ✓
M84.352 Stress fracture, left femur ✓
M23.611 Other spontaneous disruption of anterior cruciate ligament of right knee ✓
M23.621 Other spontaneous disruption of posterior cruciate ligament of right knee ✓
M25.311 Other instability, right shoulder ✓
M40.202 Unspecified kyphosis, cervical region ✓
M41.20 Other idiopathic scoliosis, site unspecified ✓
M46.1 Sacroiliitis, not elsewhere classified ✓
M62.411 Contracture of muscle, right shoulder ✓
M67.311 Transient synovitis, right shoulder ✓
M70.30 Prepatellar bursitis, unspecified knee ✓
M75.20 Bicipital tendinitis, unspecified shoulder ✓
M76.00 Gluteal tendinitis, unspecified hip ✓
M76.50 Patellar tendinitis, unspecified knee ✓
M79.1 Myalgia, unspecified site ✓
Z96.641 Presence of right artificial knee joint ✓
Z96.611 Presence of right artificial hip joint ✓

Source: CMS ICD-10-CM Official Code Set FY 2026

Is Your Orthopedics Practice Losing Revenue to Coding Errors?

OmniMD’s Orthopedics EHR suggests the right ICD-10 and CPT codes at the point of care, reducing claim denials from day one.

Schedule a Free Demo  View OmniMD Orthopedics EHR ›

Common CPT Codes for Orthopedics Billing

CPT Code Description Medicare Rate* Common Modifiers
27447 Total knee arthroplasty N/A (facility) -LT, -RT, -50, -62
27130 Total hip arthroplasty N/A (facility) -LT, -RT, -50, -62
29827 Arthroscopy, shoulder, surgical; with rotator cuff repair N/A (facility) -LT, -RT, -59
27570 Manipulation of knee joint under general anesthesia ~$245 -LT, -RT, -23
20610 Arthrocentesis, aspiration and/or injection, major joint ~$79 -25, -59, -LT, -RT
99213 Office visit, established patient, moderate complexity (15-29 min) ~$94 -25, -32, -95, -GT
99214 Office visit, established patient, high complexity (30-39 min) ~$134 -25, -32, -95, -GT
27331 Arthroscopy, knee, diagnostic with or without synovial biopsy N/A (facility) -LT, -RT, -59
29881 Arthroscopy, knee, surgical; with meniscectomy N/A (facility) -LT, -RT, -59
27245 Treatment of intertrochanteric femoral fracture, with intramedullary implant N/A (facility) -LT, -RT, -62
20680 Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod) ~$462 -LT, -RT, -59, -78
73721 MRI, any joint of lower extremity, without contrast ~$372 -LT, -RT, -26, -TC
73523 Radiologic exam, hips, bilateral, minimum 3 views ~$52 -26, -TC
97110 Therapeutic exercises, each 15 minutes ~$33 -GP, -59, -KX
20550 Injection(s); single tendon sheath, or ligament, aponeurosis ~$61 -25, -59, -LT, -RT
64483 Transforaminal epidural injection, lumbar or sacral, single level ~$165 -50, -LT, -RT, -59

*Approximate 2025 CMS national non-facility rate. Rates vary by geography, setting, and payer contract. Refer to the CMS Physician Fee Schedule for official rates.

Top Denial Reasons for Orthopedics Claims

⚠

Medical Necessity Not Adequately Documented

Payers frequently deny orthopedic claims when chart notes lack documented conservative treatment history, functional limitations, or imaging findings supporting the procedure. Ensure visit notes explicitly connect the diagnosis to the billed service with measurable functional deficits.

⚠

Missing or Incorrect Laterality Modifier (-LT/-RT)

Orthopedic procedures on paired anatomical sites (knees, hips, shoulders) require -LT or -RT modifiers; submission without them results in automatic denial or claim suspension. Always verify the modifier matches the laterality documented in the operative or procedure note before submitting.

⚠

Prior Authorization Not Obtained or Expired

Major orthopedic surgeries (total joint replacements, arthroscopic repairs) and advanced imaging (MRI) routinely require prior authorization, and performing them without valid auth is a top denial trigger. Confirm authorization numbers are current, match the scheduled procedure code, and are entered on the claim before submission.

⚠

Unbundling or Incorrect Use of Modifier -59

Billing separate injections, manipulation, or diagnostic services on the same date as a surgical procedure without proper documentation of distinct sessions frequently triggers bundling edits and denials. Use modifier -59 (or XS/XU/XP/XE) only when the services are truly separate and support documentation is in the record.

Orthopedics Billing & Coding Tips

  • Always append the 7th character for fracture codes — ‘A’ for initial encounter, ‘D’ for subsequent, ‘S’ for sequela.
  • Specify laterality (right vs. left) for all extremity codes — unspecified-side codes are flagged for medical review by most payers.
  • Separate surgical CPT codes from E&M codes using modifier -25 only when a separate, documented E&M service is performed on the same day.
  • 27447 (total knee replacement) requires documentation of conservative treatment failure prior to authorization from most commercial insurers.

Frequently Asked Questions

What is the ICD-10 code for knee osteoarthritis?

M17.11 (right knee) and M17.12 (left knee) are the primary codes for primary osteoarthritis. Always document laterality. For bilateral, use M17.0. Avoid M17.9 (unspecified) as it may trigger payer queries.

What 7th character is used for fracture initial encounters?

Use ‘A’ for the initial encounter for a closed fracture. ‘B’ is for open fractures (types I–III). ‘D’ is for subsequent encounters. ‘S’ is for sequela. The 7th character is mandatory — claims without it will be rejected.

What CPT code is used for knee replacement?

27447 is total knee arthroplasty (both components). 27446 is unicompartmental (partial). The distinction must match the operative report exactly.

Does M54.5 (low back pain) require additional codes?

M54.5 is billable as a standalone code. However, when low back pain is due to a specific condition (e.g., disc herniation M51.16, spinal stenosis M48.06), code the underlying condition first, with M54.5 as an additional code if not integral to the underlying condition.

How does OmniMD support orthopedic coding?

OmniMD’s Orthopedic EHR includes pre-built orthopedic note templates with integrated ICD-10 and CPT code libraries, reducing coding time and improving first-pass claim acceptance rates.

Streamline Your Orthopedics Practice with OmniMD

Purpose-built EHR, billing, and practice management for Orthopedics practices.

Book a Free Demo