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ICD-10 Guide
ICD-10 CodesM66.12

M66.12

Billable

Rupture of synovium, elbow

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M66.12 is a billable code used to indicate a diagnosis of rupture of synovium, elbow.

Key Diagnostic Point:

Rupture of the synovium in the elbow is a condition characterized by the tearing of the synovial membrane that lines the joint capsule. This membrane plays a crucial role in producing synovial fluid, which lubricates the joint and nourishes the cartilage. A rupture can occur due to trauma, repetitive strain, or underlying inflammatory conditions such as rheumatoid arthritis or gout. Symptoms typically include localized pain, swelling, and reduced range of motion in the elbow. Diagnosis is often confirmed through physical examination and imaging studies, such as MRI or ultrasound, which can reveal fluid accumulation or structural damage. Treatment may involve conservative measures like rest, ice, and anti-inflammatory medications, or more invasive procedures such as arthroscopy or surgical repair, depending on the severity of the rupture and associated symptoms. Proper management is essential to restore function and prevent long-term complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between acute and chronic ruptures
  • Identifying associated conditions like tenosynovitis
  • Understanding the implications of surgical versus non-surgical treatment
  • Documenting the extent of the rupture and any related injuries

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify whether the rupture is acute or chronic
  • Lack of imaging results to support the diagnosis
  • Improper coding of associated conditions

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on the mechanism of injury, physical examination findings, and imaging results.

Common Clinical Scenarios

Acute elbow injuries from sports, chronic pain in athletes, and post-surgical evaluations.

Billing Considerations

Ensure clear documentation of any surgical interventions performed.

Rheumatology

Documentation Requirements

Comprehensive history of joint symptoms, laboratory results for inflammatory markers, and imaging studies.

Common Clinical Scenarios

Patients with rheumatoid arthritis experiencing joint effusion or pain.

Billing Considerations

Document any systemic symptoms that may indicate an underlying rheumatologic condition.

Coding Guidelines

Inclusion Criteria

Use M66.12 When
  • Follow official ICD
  • CM guidelines for coding and reporting
  • Ensure accurate documentation of the condition's specifics, including the location and nature of the rupture

Exclusion Criteria

Do NOT use M66.12 When
  • Exclude conditions that do not meet the criteria for M66

Related ICD-10 Codes

Related CPT Codes

29800CPT Code

Arthroscopy, elbow, diagnostic

Clinical Scenario

Used when performing a diagnostic arthroscopy to evaluate the extent of the synovial rupture.

Documentation Requirements

Document the findings during the arthroscopy and any interventions performed.

Specialty Considerations

Orthopedic surgeons should ensure detailed operative notes are available.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of synovial disorders, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of synovial disorders, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of synovial rupture in the elbow?

Common causes include acute trauma, repetitive strain injuries, and underlying inflammatory conditions such as rheumatoid arthritis.