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ICD-10 Guide
ICD-10 CodesM66.829

M66.829

Billable

Spontaneous rupture of other tendons, unspecified upper arm

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

Code Description

ICD-10 M66.829 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, unspecified upper arm.

Key Diagnostic Point:

Spontaneous rupture of tendons in the upper arm can occur due to various factors, including degenerative changes, overuse, or trauma. This condition is characterized by the sudden tearing of tendon fibers, which may lead to pain, swelling, and functional impairment of the affected arm. The upper arm contains several important tendons, including those associated with the biceps and triceps muscles. The rupture may be accompanied by tenosynovitis, an inflammation of the synovial sheath surrounding the tendon, which can exacerbate symptoms and complicate recovery. Diagnosis typically involves a thorough clinical examination, imaging studies such as ultrasound or MRI, and assessment of the patient's history. Treatment options may include conservative management with rest, ice, and physical therapy, or surgical intervention to repair the torn tendon, depending on the severity of the rupture and the patient's functional needs. Accurate coding is essential for proper reimbursement and to reflect the complexity of the condition and its management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of tendon rupture
  • Differentiation from other tendon injuries and conditions
  • Need for precise documentation of the mechanism of injury
  • Potential for associated conditions like tenosynovitis

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the exact tendon involved
  • Lack of imaging studies to support diagnosis
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging results, and pre-operative assessments are essential.

Common Clinical Scenarios

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

Billing Considerations

Documentation must clearly outline the surgical approach and any complications encountered during repair.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations including functional assessments and treatment plans.

Common Clinical Scenarios

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

Billing Considerations

Focus on documenting progress and functional outcomes to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use M66.829 When
  • According to ICD
  • 10 guidelines, M66
  • 829 should be used when the specific tendon involved is not documented
  • Coders should ensure that the clinical documentation supports the diagnosis and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use M66.829 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Repair of ruptured tendon, upper arm

Clinical Scenario

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

Documentation Requirements

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

Specialty Considerations

Orthopedic surgeons must document the specific tendon repaired 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 injuries, improving the accuracy of diagnoses and treatment tracking. M66.829 provides a clear classification for spontaneous ruptures, facilitating better patient management and reimbursement processes.

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 tracking. M66.829 provides a clear classification for spontaneous ruptures, facilitating better patient management and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 M66.829 and M66.828?

M66.829 refers specifically to spontaneous ruptures of tendons in the upper arm, while M66.828 pertains to those in the lower arm. Accurate coding depends on the anatomical location of the injury.