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v1.0.0
ICD-10 Guide
ICD-10 CodesM66.35

M66.35

Billable

Spontaneous rupture of flexor tendons, thigh

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

Code Description

ICD-10 M66.35 is a billable code used to indicate a diagnosis of spontaneous rupture of flexor tendons, thigh.

Key Diagnostic Point:

Spontaneous rupture of flexor tendons in the thigh is a rare but significant condition that typically occurs without any preceding trauma or identifiable cause. This condition is characterized by the sudden tearing of the flexor tendons, which are responsible for bending the knee and controlling movement in the thigh. The rupture can lead to acute pain, swelling, and loss of function in the affected limb. Patients may present with a palpable defect in the tendon, and diagnostic imaging, such as MRI or ultrasound, may be utilized to confirm the diagnosis. The underlying mechanisms may involve degenerative changes, inflammatory processes, or systemic conditions that weaken the tendon structure. Treatment often requires surgical intervention to repair the ruptured tendon, followed by rehabilitation to restore function and strength. Understanding the nuances of this condition is crucial for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of the rupture
  • Need for precise documentation of the spontaneous nature of the rupture
  • Differentiation from traumatic tendon injuries
  • Potential for co-existing conditions affecting tendon health

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture
  • Failure to document associated conditions that may contribute to tendon health
  • Misclassification of the rupture as traumatic rather than spontaneous
  • Lack of detailed operative reports for surgical repairs

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and post-operative notes are essential for accurate coding.

Common Clinical Scenarios

Patients presenting with acute knee pain and swelling, often after minimal or no trauma.

Billing Considerations

Documentation must clearly indicate the spontaneous nature of the rupture and any underlying conditions.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation progress.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery for tendon repair.

Billing Considerations

Focus on documenting functional outcomes and therapy interventions.

Coding Guidelines

Inclusion Criteria

Use M66.35 When
  • According to ICD
  • 10 guidelines, M66
  • 35 should be used when the rupture is spontaneous and not due to trauma
  • Coders must ensure that documentation supports the diagnosis and that any associated conditions are noted

Exclusion Criteria

Do NOT use M66.35 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27301CPT Code

Repair of tendon, flexor, thigh

Clinical Scenario

Used when surgical repair is performed for spontaneous tendon rupture.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the nature of the rupture and the surgical approach.

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 data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spontaneous tendon ruptures, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 flexor tendons?

The primary cause is often related to degenerative changes in the tendon, which can be exacerbated by systemic conditions such as rheumatoid arthritis or diabetes.