Spontaneous rupture of other tendons, right upper arm
ICD-10 M66.821 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, right upper arm.
Spontaneous rupture of tendons in the right upper arm is a condition characterized by the sudden tearing of tendons without any significant trauma or injury. This condition often occurs in individuals with underlying tendon degeneration, which may be due to chronic overuse, inflammatory conditions, or age-related changes. The tendons in the upper arm, such as the biceps or triceps tendons, can be affected, leading to pain, swelling, and functional impairment. Patients may present with acute pain and a noticeable loss of strength or range of motion in the affected arm. Diagnosis typically involves a thorough clinical examination, imaging studies such as ultrasound or MRI, and sometimes, diagnostic injections. Treatment options may include conservative management with rest, ice, and physical therapy, or surgical intervention to repair the ruptured tendon, depending on the severity of the rupture and the patient's functional needs. Accurate coding is essential for appropriate reimbursement and to reflect the complexity of the patient's condition.
Detailed notes on the mechanism of injury, physical examination findings, and imaging results.
Patients presenting with acute shoulder pain and weakness, often after repetitive overhead activities.
Ensure that the documentation clearly states the spontaneous nature of the rupture and any prior tendon issues.
Comprehensive assessment of functional limitations and rehabilitation goals.
Patients requiring rehabilitation post-surgery for tendon repair or those managing chronic pain from tendon degeneration.
Document the patient's functional status and response to therapy to support ongoing treatment.
Used when surgical repair is performed for a spontaneous rupture of the tendon.
Operative report detailing the procedure and findings.
Orthopedic surgeons should ensure that the surgical notes clearly indicate the nature of the rupture.
Spontaneous tendon rupture occurs without significant trauma, often due to underlying degeneration, while traumatic rupture results from an acute injury or force applied to the tendon.
