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ICD-10 Guide
ICD-10 CodesM66.3

M66.3

Billable

Spontaneous rupture of flexor tendons

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

Code Description

ICD-10 M66.3 is a billable code used to indicate a diagnosis of spontaneous rupture of flexor tendons.

Key Diagnostic Point:

Spontaneous rupture of flexor tendons refers to the unexpected tearing of the tendons that flex the fingers and thumb, often occurring without a significant traumatic event. This condition can arise due to various factors, including chronic inflammation, degenerative changes, or underlying systemic diseases such as rheumatoid arthritis or diabetes. The flexor tendons are crucial for hand function, allowing for gripping and manipulation of objects. When these tendons rupture, patients may experience acute pain, swelling, and loss of function in the affected digit. Diagnosis typically involves a thorough clinical examination, imaging studies such as ultrasound or MRI, and sometimes surgical exploration. Treatment often requires surgical repair to restore function, followed by rehabilitation to regain strength and mobility. The prognosis depends on the extent of the injury and the timeliness of intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of tendon rupture
  • Need for precise documentation of the mechanism of injury
  • Differentiation from other tendon injuries and conditions
  • Potential for co-existing conditions affecting treatment and coding

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture
  • Failure to document co-existing conditions that may affect treatment
  • Misclassification of the type of tendon injury
  • Lack of clarity in the surgical procedure performed

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, including the type of repair performed and any complications.

Common Clinical Scenarios

Patients presenting with acute hand pain and loss of function after a spontaneous rupture.

Billing Considerations

Ensure documentation reflects the urgency of surgical intervention and any pre-existing conditions.

Physical Therapy

Documentation Requirements

Progress notes detailing rehabilitation goals, treatment modalities, and patient response.

Common Clinical Scenarios

Patients recovering from tendon repair surgery requiring rehabilitation.

Billing Considerations

Document the specific exercises and modalities used to support recovery.

Coding Guidelines

Inclusion Criteria

Use M66.3 When
  • Follow official coding guidelines for reporting tendon injuries, ensuring accurate documentation of the mechanism of injury and any associated conditions
  • Include details about the surgical procedure if applicable

Exclusion Criteria

Do NOT use M66.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

26301CPT Code

Repair of flexor tendon

Clinical Scenario

Used when surgical repair is performed for a spontaneous rupture.

Documentation Requirements

Operative report detailing the procedure and any complications.

Specialty Considerations

Orthopedic surgeons should ensure clarity in the surgical approach and technique used.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

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

Resources

Clinical References

  • •
    American Academy of Orthopaedic Surgeons

Coding & Billing References

  • •
    American Academy of Orthopaedic Surgeons

Frequently Asked Questions

What is the primary cause of spontaneous rupture of flexor tendons?

Spontaneous ruptures can be caused by chronic inflammation, degenerative changes, or systemic diseases such as rheumatoid arthritis or diabetes, leading to weakening of the tendon structure.