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ICD-10 Guide
ICD-10 CodesM66.859

M66.859

Billable

Spontaneous rupture of other tendons, unspecified thigh

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

Code Description

ICD-10 M66.859 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, unspecified thigh.

Key Diagnostic Point:

Spontaneous rupture of tendons in the thigh region can occur due to various factors, including underlying degenerative conditions, acute trauma, or chronic overuse. This condition is characterized by the sudden tearing of tendons, which may lead to significant pain, swelling, and functional impairment. The thigh contains several important tendons, including those associated with the quadriceps and hamstring muscles. Ruptures can result in loss of strength and mobility, necessitating a thorough clinical evaluation. Diagnosis typically involves a combination of physical examination and imaging studies, such as MRI or ultrasound, to confirm the extent of the injury. Treatment may vary from conservative management, including rest and physical therapy, to surgical intervention for severe cases. Surgical repair aims to restore tendon integrity and function, and rehabilitation is crucial for optimal recovery. Accurate coding is essential for proper reimbursement and tracking of treatment outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of tendon ruptures.
  • Need for precise documentation of the specific tendon involved.
  • Differentiation from other tendon injuries and conditions.
  • Potential for co-existing musculoskeletal disorders.

Audit Risk Factors

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

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Acute sports injuries leading to tendon rupture, chronic overuse injuries in athletes.

Billing Considerations

Ensure clarity on the specific tendon affected and the treatment plan.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Post-surgical rehabilitation following tendon repair.

Billing Considerations

Document progress and response to therapy to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use M66.859 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the clinical scenario
  • Include details on the specific tendon involved and any associated conditions

Exclusion Criteria

Do NOT use M66.859 When
  • Exclude conditions that are not spontaneous ruptures

Related ICD-10 Codes

Related CPT Codes

27301CPT Code

Repair of tendon, thigh

Clinical Scenario

Used when surgical repair is performed following a spontaneous rupture.

Documentation Requirements

Document the surgical procedure details, including the tendon repaired and the approach used.

Specialty Considerations

Orthopedic surgeons should ensure that the surgical notes clearly correlate with the diagnosis.

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. M66.859 provides a clear designation 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. M66.859 provides a clear designation 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 spontaneous and traumatic tendon rupture?

Spontaneous tendon rupture occurs without a specific traumatic event, often due to underlying degeneration, while traumatic rupture is a direct result of an injury or accident.