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ICD-10 Guide
ICD-10 CodesM66.222

M66.222

Billable

Spontaneous rupture of extensor tendons, left upper arm

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

Code Description

ICD-10 M66.222 is a billable code used to indicate a diagnosis of spontaneous rupture of extensor tendons, left upper arm.

Key Diagnostic Point:

Spontaneous rupture of extensor tendons in the left upper arm is a condition characterized by the unexpected tearing of the extensor tendons that facilitate the extension of the elbow and wrist. This injury can occur due to various factors, including chronic degeneration of the tendon, overuse, or underlying systemic conditions such as rheumatoid arthritis or diabetes. 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 the extent of the rupture. Treatment options may include conservative management with rest and physical therapy or surgical intervention to repair the torn tendon, depending on the severity of the rupture and the patient's functional needs. Accurate coding is essential for proper reimbursement and tracking of treatment outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures
  • Identifying the specific location of the tendon rupture
  • Understanding the patient's medical history and comorbidities
  • Documenting the extent of the injury and treatment plan

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture
  • Failure to specify the exact tendon involved
  • Lack of imaging studies to support the diagnosis
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on the mechanism of injury, imaging results, and treatment plan.

Common Clinical Scenarios

Patients presenting with sudden onset pain and functional loss in the upper arm.

Billing Considerations

Ensure that all relevant imaging and surgical notes are included to support the diagnosis.

Rheumatology

Documentation Requirements

Comprehensive history of systemic conditions and their impact on tendon health.

Common Clinical Scenarios

Patients with underlying rheumatologic conditions presenting with tendon ruptures.

Billing Considerations

Document any systemic factors contributing to tendon degeneration.

Coding Guidelines

Inclusion Criteria

Use M66.222 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the rupture is spontaneous and specifically located in the left upper arm

Exclusion Criteria

Do NOT use M66.222 When
  • Exclude cases of traumatic ruptures or those involving other anatomical locations

Related ICD-10 Codes

Related CPT Codes

24357CPT Code

Repair of ruptured tendon, extensor, upper arm

Clinical Scenario

Used when surgical repair is performed for a spontaneous rupture.

Documentation Requirements

Surgical notes detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should document the extent of the rupture and repair.

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 data collection. M66.222 provides a clear distinction for spontaneous ruptures, enhancing clinical understanding and treatment tracking.

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 data collection. M66.222 provides a clear distinction for spontaneous ruptures, enhancing clinical understanding and treatment tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the accuracy of claims and data collection. M66.222 provides a clear distinction for spontaneous ruptures, enhancing clinical understanding and treatment tracking.

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 ruptures?

Spontaneous ruptures occur without a specific traumatic event, often due to degeneration or underlying conditions, while traumatic ruptures result from a specific injury or accident.