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v1.0.0
ICD-10 Guide
ICD-10 CodesM66.82

M66.82

Billable

Spontaneous rupture of other tendons, upper arm

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

Code Description

ICD-10 M66.82 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, upper arm.

Key Diagnostic Point:

Spontaneous rupture of tendons in the upper arm, such as the biceps or triceps tendons, can occur due to various factors including age-related degeneration, chronic overuse, or acute trauma. This condition is characterized by the sudden tearing of the tendon fibers, which may lead to significant pain, swelling, and loss of function in the affected arm. Patients often present with a 'popping' sensation at the time of injury, followed by immediate pain and bruising. The diagnosis is typically confirmed through physical examination and imaging studies such as MRI or ultrasound, which can visualize the extent of the rupture. Treatment options may include conservative management with rest and physical therapy, or surgical intervention to repair the torn tendon, especially in cases where the rupture leads to significant functional impairment. Understanding the underlying causes, such as tenosynovitis or other synovial disorders, is crucial for effective management and prevention of recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures
  • Identifying the specific tendon involved
  • Documenting associated conditions like tenosynovitis
  • Understanding the implications of surgical versus conservative treatment

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the tendon involved
  • Misclassification of spontaneous versus traumatic rupture
  • Lack of imaging studies to support the diagnosis

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging results, and pre/post-operative assessments.

Common Clinical Scenarios

Surgical repair of ruptured biceps tendon, management of chronic tendonitis leading to rupture.

Billing Considerations

Ensure clear documentation of the surgical approach and any complications.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations, treatment plans, and progress notes.

Common Clinical Scenarios

Rehabilitation post-tendon repair, management of pain and functional limitations.

Billing Considerations

Document functional assessments and patient progress meticulously.

Coding Guidelines

Inclusion Criteria

Use M66.82 When
  • Follow official ICD
  • CM guidelines for coding tendon injuries, ensuring accurate documentation of the type of rupture and any associated conditions
  • Include relevant history and physical exam findings

Exclusion Criteria

Do NOT use M66.82 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Repair of ruptured tendon, biceps

Clinical Scenario

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

Documentation Requirements

Operative report detailing the procedure, findings, and post-operative care.

Specialty Considerations

Orthopedic surgeons should ensure clear documentation of the surgical approach and any complications.

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 diagnosis and treatment tracking. M66.82 provides a distinct code for spontaneous ruptures, enhancing data collection and analysis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon ruptures, improving the accuracy of diagnosis and treatment tracking. M66.82 provides a distinct code for spontaneous ruptures, enhancing data collection and analysis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of tendon ruptures, improving the accuracy of diagnosis and treatment tracking. M66.82 provides a distinct code for spontaneous ruptures, enhancing data collection and analysis.

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 are the common causes of spontaneous tendon rupture?

Common causes include age-related degeneration, chronic overuse, and underlying conditions such as tenosynovitis or systemic diseases that weaken tendon integrity.