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ICD-10 Guide
ICD-10 CodesM66.351

M66.351

Billable

Spontaneous rupture of flexor tendons, right thigh

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

Code Description

ICD-10 M66.351 is a billable code used to indicate a diagnosis of spontaneous rupture of flexor tendons, right thigh.

Key Diagnostic Point:

Spontaneous rupture of flexor tendons in the right thigh is a condition characterized by the unexpected tearing of the flexor tendons, which are responsible for bending the knee and controlling movement in the thigh region. This condition can occur due to various factors, including underlying degenerative changes, inflammatory processes, or trauma. Patients may present with acute pain, swelling, and loss of function in the affected area. 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 often involves surgical intervention to repair the torn tendon, followed by rehabilitation to restore function. The prognosis depends on the severity of the rupture and the timeliness of the intervention. In cases where the rupture is associated with tenosynovitis or other synovial disorders, comprehensive management of the underlying condition is crucial for optimal recovery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures
  • Identifying the specific tendon involved
  • Understanding associated conditions like tenosynovitis
  • Documenting the laterality of the condition accurately

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture
  • Failure to specify the laterality of the condition
  • Misidentification of the tendon involved
  • Lack of supporting imaging documentation

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging studies, and pre-operative assessments are essential.

Common Clinical Scenarios

Patients presenting with acute knee pain and swelling, often after minimal trauma or in the context of chronic conditions.

Billing Considerations

Ensure that the surgical procedure performed is clearly linked to the diagnosis of spontaneous tendon rupture.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive rehabilitation plans and progress notes detailing functional limitations.

Common Clinical Scenarios

Patients recovering from tendon repair surgery requiring physical therapy.

Billing Considerations

Document the patient's functional status and response to therapy to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use M66.351 When
  • According to ICD
  • 10 guidelines, M66
  • 351 should be used when the rupture is spontaneous and specifically involves the flexor tendons of the right thigh
  • Coders must ensure that the documentation supports the diagnosis and includes details about the nature of the rupture

Exclusion Criteria

Do NOT use M66.351 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 indication for surgery.

Specialty Considerations

Orthopedic surgeons must ensure that the procedure is clearly linked to the diagnosis.

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. This specificity aids in better tracking of outcomes and resource utilization.

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. This specificity aids in better tracking of outcomes and resource utilization.

Reimbursement & Billing Impact

reimbursement processes. This specificity aids in better tracking of outcomes and resource utilization.

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 a significant external force, often due to underlying conditions, while traumatic rupture results from a specific injury or trauma.