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ICD-10 Guide
ICD-10 CodesM66.221

M66.221

Billable

Spontaneous rupture of extensor tendons, right upper arm

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

Code Description

ICD-10 M66.221 is a billable code used to indicate a diagnosis of spontaneous rupture of extensor tendons, right upper arm.

Key Diagnostic Point:

Spontaneous rupture of extensor tendons in the right upper arm is a condition characterized by the unexpected tearing of the extensor tendons, which are responsible for extending the fingers and wrist. This injury can occur without any significant trauma or pre-existing conditions, often seen in individuals with underlying degenerative changes or inflammatory conditions affecting the tendons. Patients may present with sudden pain, swelling, and loss of function in the affected area. Diagnosis typically involves a thorough clinical examination and imaging studies such as ultrasound or MRI to confirm the rupture. Treatment may vary from conservative management, including rest and physical therapy, to surgical intervention for tendon repair, especially in cases where functionality is severely compromised. The prognosis is generally favorable with appropriate treatment, although recovery may take time depending on the extent of the injury and the patient's overall health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures
  • Understanding the anatomical location and specific tendon involvement
  • Variability in clinical presentation and severity of symptoms
  • Need for imaging studies to confirm diagnosis

Audit Risk Factors

  • Inadequate documentation of the mechanism of rupture
  • Failure to specify laterality
  • Lack of imaging reports to support diagnosis
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging studies, and post-operative care plans.

Common Clinical Scenarios

Surgical repair of ruptured extensor tendons following diagnosis.

Billing Considerations

Ensure clear documentation of tendon involvement and surgical techniques used.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and rehabilitation plans.

Common Clinical Scenarios

Rehabilitation following tendon repair surgery.

Billing Considerations

Document progress notes and functional assessments to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use M66.221 When
  • Follow official coding guidelines for reporting tendon injuries, ensuring accurate documentation of the rupture's nature and location
  • Include any relevant co
  • existing conditions that may affect treatment

Exclusion Criteria

Do NOT use M66.221 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Repair of ruptured tendon

Clinical Scenario

Used when surgical repair is performed for the spontaneous rupture.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic documentation must specify the tendon repaired.

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 claims and facilitating better patient care through detailed documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the accuracy of claims and facilitating better patient care through detailed documentation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the accuracy of claims and facilitating better patient care through detailed documentation.

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 difference between spontaneous and traumatic tendon rupture?

Spontaneous tendon rupture occurs without significant trauma, often due to degenerative changes, while traumatic rupture results from a specific injury or event.