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v1.0.0
ICD-10 Guide
ICD-10 CodesM66.159

M66.159

Billable

Rupture of synovium, unspecified hip

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

Code Description

ICD-10 M66.159 is a billable code used to indicate a diagnosis of rupture of synovium, unspecified hip.

Key Diagnostic Point:

Rupture of the synovium in the hip joint is a condition characterized by the tearing of the synovial membrane, which lines the joint capsule and produces synovial fluid. This condition can result from acute trauma, chronic overuse, or underlying inflammatory diseases such as rheumatoid arthritis. Patients may present with symptoms including joint pain, swelling, and decreased range of motion. The rupture can lead to synovitis, which is inflammation of the synovial membrane, and may complicate the clinical picture with additional symptoms such as warmth and tenderness around the joint. Diagnosis typically involves a thorough clinical examination, imaging studies such as MRI or ultrasound, and sometimes arthroscopy for direct visualization. Treatment options may include conservative management with rest, ice, and anti-inflammatory medications, or surgical intervention to repair the synovium if conservative measures fail. Accurate coding is essential for proper reimbursement and tracking of treatment outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Need for precise documentation of the rupture's cause
  • Differentiation from other synovial disorders
  • Potential for co-existing conditions affecting the hip

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify laterality when applicable
  • Lack of imaging or clinical evidence supporting the diagnosis
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Acute trauma leading to hip pain, chronic pain in athletes, and post-surgical complications.

Billing Considerations

Ensure documentation reflects the severity of the rupture and any associated injuries.

Rheumatology

Documentation Requirements

Comprehensive assessment of underlying inflammatory conditions, including lab results and treatment history.

Common Clinical Scenarios

Patients with rheumatoid arthritis presenting with hip pain and swelling.

Billing Considerations

Document any systemic symptoms or comorbidities that may influence treatment.

Coding Guidelines

Inclusion Criteria

Use M66.159 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the condition's specifics, including laterality and associated conditions
  • The code is included under the category for disorders of synovium and tendon

Exclusion Criteria

Do NOT use M66.159 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

29870CPT Code

Arthroscopy, hip, diagnostic

Clinical Scenario

Used when a patient presents with hip pain and a suspected synovial rupture.

Documentation Requirements

Document indications for the procedure, findings, and any interventions performed.

Specialty Considerations

Orthopedic surgeons should ensure detailed operative notes are provided.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like synovial rupture, improving the granularity of data for treatment outcomes and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like synovial rupture, improving the granularity of data for treatment outcomes and reimbursement.

Reimbursement & Billing Impact

reimbursement.

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?

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

How is a synovial rupture diagnosed?

Diagnosis typically involves a combination of clinical examination, imaging studies such as MRI or ultrasound, and sometimes arthroscopy.

What are the treatment options for a ruptured synovium?

Treatment may include conservative measures like rest and anti-inflammatories, or surgical intervention if conservative treatment fails.