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ICD-10 Guide
ICD-10 CodesM66.25

M66.25

Billable

Spontaneous rupture of extensor tendons, thigh

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

Code Description

ICD-10 M66.25 is a billable code used to indicate a diagnosis of spontaneous rupture of extensor tendons, thigh.

Key Diagnostic Point:

Spontaneous rupture of extensor tendons in the thigh is a condition characterized by the unexpected tearing of the extensor tendons, which are responsible for extending the knee and stabilizing the leg during movement. This condition can occur due to various factors, including underlying degenerative changes, inflammatory conditions, or acute trauma. Patients may present with sudden pain, swelling, and loss of function in the affected leg. The diagnosis is typically confirmed through clinical examination and imaging studies such as MRI or ultrasound, which can visualize the extent of the tendon rupture. Treatment options may include conservative management with rest and physical therapy or surgical intervention to repair the ruptured tendon, depending on the severity of the injury and the patient's overall health. Understanding the underlying causes, such as tenosynovitis or other synovial disorders, is crucial for effective management and prevention of recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures
  • Understanding the anatomical location and function of extensor tendons
  • Identifying associated conditions like tenosynovitis
  • Variability in surgical repair techniques

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

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging results, and pre-operative assessments.

Common Clinical Scenarios

Patients presenting with acute knee pain following a fall or sports injury.

Billing Considerations

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

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations of functional limitations and rehabilitation progress.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery for tendon repair.

Billing Considerations

Documenting the patient's response to therapy and any modifications to the rehabilitation plan.

Coding Guidelines

Inclusion Criteria

Use M66.25 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the diagnosis, treatment, and any associated conditions
  • Include details about the mechanism of injury and the specific tendon involved

Exclusion Criteria

Do NOT use M66.25 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27301CPT Code

Repair of tendon, extensor, thigh

Clinical Scenario

Used when surgical repair is performed for a spontaneous rupture.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should 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 ruptures, improving the accuracy of diagnoses and treatment plans. M66.25 provides a clear distinction between spontaneous and traumatic ruptures, aiding in appropriate management and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon ruptures, improving the accuracy of diagnoses and treatment plans. M66.25 provides a clear distinction between spontaneous and traumatic ruptures, aiding in appropriate management 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 spontaneous rupture of extensor tendons?

Common causes include degenerative changes due to aging, inflammatory conditions such as rheumatoid arthritis, and overuse injuries. Patients may also have a history of chronic tendonitis or previous tendon injuries.