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ICD-10 Guide
ICD-10 CodesM66.8

M66.8

Billable

Spontaneous rupture of other tendons

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

Code Description

ICD-10 M66.8 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons.

Key Diagnostic Point:

Spontaneous rupture of tendons is a condition characterized by the unexpected tearing of tendons without any significant trauma or injury. This can occur in various tendons throughout the body, particularly in the context of underlying conditions such as tenosynovitis, which is the inflammation of the synovial sheath surrounding a tendon. The rupture may lead to acute pain, swelling, and loss of function in the affected area. Commonly affected tendons include those in the shoulder, wrist, and ankle. The condition may be associated with systemic diseases, such as rheumatoid arthritis or diabetes, which can weaken tendon integrity. Diagnosis typically involves a thorough clinical examination, imaging studies such as ultrasound or MRI, and sometimes, laboratory tests to rule out underlying conditions. Treatment may vary from conservative management, including rest and physical therapy, to surgical intervention for severe cases where tendon repair is necessary. Accurate coding is essential for proper reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying conditions that can lead to spontaneous rupture.
  • Differentiation from traumatic tendon ruptures.
  • Need for detailed documentation of clinical findings.
  • Potential for co-existing conditions that complicate coding.

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture.
  • Failure to document co-existing conditions.
  • Misidentification of the specific tendon involved.
  • Lack of imaging or clinical evidence to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with acute pain and swelling in joints, particularly after minimal or no trauma.

Billing Considerations

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

Rheumatology

Documentation Requirements

Comprehensive history of systemic conditions, lab results, and treatment history.

Common Clinical Scenarios

Patients with autoimmune disorders presenting with tendon issues.

Billing Considerations

Consideration of systemic factors that may contribute to tendon weakness.

Coding Guidelines

Inclusion Criteria

Use M66.8 When
  • According to ICD
  • 10 guidelines, M66
  • 8 should be used when the specific tendon involved is not classified elsewhere
  • It is important to document the spontaneous nature of the rupture and any relevant clinical findings

Exclusion Criteria

Do NOT use M66.8 When
  • Exclusion criteria include traumatic ruptures and ruptures due to specific diseases that have their own codes

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Repair of ruptured tendon, shoulder

Clinical Scenario

Used when surgical repair is performed for a spontaneous rupture of the shoulder tendon.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should document the specific tendon repaired.

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 claims and the ability to track outcomes related to spontaneous tendon injuries.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon ruptures, improving the accuracy of claims and the ability to track outcomes related to spontaneous tendon injuries.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of tendon ruptures, improving the accuracy of claims and the ability to track outcomes related to spontaneous tendon injuries.

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 significant trauma, often due to underlying conditions, while traumatic rupture is a direct result of injury or excessive force applied to the tendon.