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ICD-10 Guide
ICD-10 CodesM66.22

M66.22

Billable

Spontaneous rupture of extensor tendons, upper arm

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

Code Description

ICD-10 M66.22 is a billable code used to indicate a diagnosis of spontaneous rupture of extensor tendons, upper arm.

Key Diagnostic Point:

Spontaneous rupture of extensor tendons in the upper arm is a condition characterized by the unexpected tearing of the extensor tendons, which are responsible for extending the fingers and wrist. This condition can occur due to various factors, including underlying degenerative changes, inflammatory conditions, or trauma. Patients may present with sudden pain, swelling, and loss of function in the affected arm. The diagnosis is typically confirmed through clinical examination and imaging studies, such as ultrasound or MRI, which can visualize tendon integrity. Treatment often involves surgical intervention to repair the ruptured tendon, followed by rehabilitation to restore function. The condition may be associated with tenosynovitis, where inflammation of the tendon sheath occurs, further complicating the clinical picture. Accurate coding is essential for proper management and reimbursement, as it reflects the severity and complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures
  • Identifying associated conditions like tenosynovitis
  • Understanding the anatomical specifics of the upper arm extensor tendons
  • Documenting the clinical presentation and imaging findings accurately

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the exact tendon involved
  • Lack of imaging studies to support the diagnosis
  • Improper coding of associated conditions like tenosynovitis

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging results, and pre-operative assessments are essential.

Common Clinical Scenarios

Patients presenting with acute pain and dysfunction in the upper arm following a fall or repetitive strain.

Billing Considerations

Ensure clear documentation of the surgical approach and any complications encountered during the procedure.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive rehabilitation plans and progress notes detailing functional outcomes.

Common Clinical Scenarios

Patients recovering from tendon repair surgery requiring physical therapy.

Billing Considerations

Documenting the patient's functional limitations and goals for therapy is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M66.22 When
  • According to ICD
  • 10 guidelines, M66
  • 22 should be used when there is clear documentation of a spontaneous rupture of extensor tendons in the upper arm

Exclusion Criteria

Do NOT use M66.22 When
  • Exclusion criteria include traumatic ruptures or ruptures of other tendon groups unless specified

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Repair of ruptured tendon, upper arm

Clinical Scenario

Used when surgical repair of the extensor tendon is performed.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the specific tendon repaired and any complications.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the accuracy of patient records and facilitating better treatment planning and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the accuracy of patient records and facilitating better treatment planning 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 is the primary cause of spontaneous rupture of extensor tendons?

Spontaneous ruptures are often associated with underlying degenerative changes, inflammatory conditions, or chronic overuse, rather than a specific traumatic event.