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2025 ICD-10-CM code M76

Enthesopathy of a lower limb, excluding the foot.

Do not use this code for enthesopathies of the ankle and foot (M77.5-) or bursitis due to use, overuse, and pressure (M70.-). Use an external cause code following M76 if applicable to identify the cause of the condition.

Medical necessity is established by the presence of signs and symptoms of enthesopathy, impacting the patient's function and quality of life. The documentation should support the diagnosis and the need for intervention.

Clinicians diagnose enthesopathy based on patient history, physical examination, imaging (X-ray, MRI, ultrasound), and laboratory tests (rheumatoid factor, antibodies, inflammatory markers, uric acid/urea, joint fluid analysis). Treatment includes analgesics, NSAIDs, corticosteroid injections, cold compresses, electrical stimulation, and physical therapy.

In simple words: Enthesopathy of the lower limb means you have pain and inflammation where your ligaments, tendons, or muscles attach to the bones in your leg, but not your foot. This can be caused by conditions like arthritis or other inflammatory diseases.

This code encompasses disorders affecting the insertion points of ligaments, tendons, or muscles into the bone in the lower limbs, excluding the foot. These disorders can arise from inflammatory conditions like arthritis, spondylitis, or even non-skeletal diseases such as Crohn's disease.

Example 1: A patient presents with pain and tenderness in their knee at the insertion point of the patellar tendon, exacerbated by activity. Imaging confirms inflammation at the enthesis, consistent with enthesopathy., A patient with Crohn's disease experiences pain and swelling in their thigh near the hip joint, unrelated to any trauma. Examination and imaging reveal enthesopathy as a secondary manifestation of their underlying condition., A patient with ankylosing spondylitis presents with stiffness and pain in their leg. Examination reveals inflammation and tenderness in their upper leg at the insertion point of a tendon, consistent with enthesopathy related to their underlying condition.

Documentation should include patient history, location and character of pain, physical exam findings (tenderness, swelling, range of motion), imaging results, laboratory findings, and any underlying conditions.

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