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ICD-10 Guide
ICD-10 CodesM66.822

M66.822

Billable

Spontaneous rupture of other tendons, left upper arm

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

Code Description

ICD-10 M66.822 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, left upper arm.

Key Diagnostic Point:

Spontaneous rupture of tendons in the left upper arm can occur due to various factors, including underlying degenerative conditions, acute trauma, or repetitive stress. 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. The left upper arm is particularly susceptible to tendon ruptures involving the biceps, triceps, and rotator cuff tendons. Patients may present with acute pain, a palpable defect in the tendon, and limited range of motion. Diagnosis typically involves a thorough clinical examination and imaging studies such as ultrasound or MRI to confirm the rupture and assess the extent of the injury. Treatment options may include conservative management with rest and physical therapy or surgical intervention to repair the torn tendon, depending on the severity of the rupture and the patient's functional demands. Proper coding for this condition is essential for accurate billing and to ensure appropriate treatment pathways are followed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures
  • Identifying the specific tendon involved
  • Understanding the implications of associated conditions like tenosynovitis
  • Documenting the severity and functional impact of the rupture

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the exact tendon involved
  • Lack of imaging studies to support the diagnosis
  • Improper coding of associated conditions like tenosynovitis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on the mechanism of injury, physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with acute pain and swelling in the left upper arm after a fall or repetitive overhead activity.

Billing Considerations

Ensure that the specific tendon involved is clearly documented to avoid coding errors.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Patients requiring rehabilitation post-surgery for tendon repair or those undergoing conservative management.

Billing Considerations

Documenting the patient's progress and response to therapy is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M66.822 When
  • According to ICD
  • 10 guidelines, this code should be used when the rupture is spontaneous and not due to an external cause
  • Documentation must support the diagnosis, including imaging results and clinical findings

Exclusion Criteria

Do NOT use M66.822 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 must document the specific tendon repaired and the surgical technique used.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the accuracy of diagnoses and treatment plans. M66.822 provides specificity that was not available in ICD-9, allowing for better tracking of spontaneous tendon ruptures.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the accuracy of diagnoses and treatment plans. M66.822 provides specificity that was not available in ICD-9, allowing for better tracking of spontaneous tendon ruptures.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the accuracy of diagnoses and treatment plans. M66.822 provides specificity that was not available in ICD-9, allowing for better tracking of spontaneous tendon ruptures.

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 an identifiable external cause, often due to degenerative changes, while traumatic rupture is the result of an acute injury or excessive force applied to the tendon.