Spontaneous rupture of other tendons, right shoulder
ICD-10 M66.811 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, right shoulder.
Spontaneous rupture of tendons in the right shoulder is a condition characterized by the unexpected tearing of tendons without any significant trauma or injury. This condition can occur due to various factors, including degenerative changes, chronic inflammation, or underlying systemic diseases. The tendons in the shoulder, such as the rotator cuff tendons, are particularly susceptible to spontaneous rupture due to their anatomical positioning and the mechanical stresses they endure during daily activities. Patients may present with sudden onset of shoulder pain, swelling, and limited range of motion. Diagnostic imaging, such as MRI or ultrasound, is often utilized to confirm the diagnosis and assess the extent of the rupture. Treatment options may include conservative management with physical therapy and anti-inflammatory medications, or surgical intervention to repair the torn tendon, depending on the severity and impact on the patient's function. Accurate coding for this condition is essential for appropriate reimbursement and to reflect the complexity of the patient's clinical scenario.
Detailed operative reports, imaging studies, and pre-operative assessments.
Patients presenting with shoulder pain and limited mobility, often after a history of chronic shoulder issues.
Ensure that the surgical procedure performed is clearly linked to the diagnosis of spontaneous tendon rupture.
Comprehensive evaluations, treatment plans, and progress notes.
Patients undergoing rehabilitation post-surgery or those managed conservatively.
Documenting functional limitations and response to therapy is crucial for accurate coding.
Used when surgical repair is performed for a spontaneous rupture of the rotator cuff.
Operative report detailing the procedure, indication for surgery, and post-operative care plan.
Orthopedic surgeons must ensure that the diagnosis aligns with the surgical procedure performed.
Spontaneous tendon rupture occurs without significant trauma, often due to degenerative changes, while traumatic rupture is a direct result of an injury or accident.
