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ICD-10 Guide
ICD-10 CodesM66.86

M66.86

Billable

Spontaneous rupture of other tendons, lower leg

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

Code Description

ICD-10 M66.86 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, lower leg.

Key Diagnostic Point:

Spontaneous rupture of tendons in the lower leg is a condition characterized by the unexpected tearing of tendons without any significant trauma or injury. This condition can occur in various tendons, including those associated with the ankle and foot, such as the peroneal tendons or the Achilles tendon. The rupture may be associated with underlying conditions such as tenosynovitis, which is inflammation of the tendon sheath, or degenerative changes due to chronic overuse. Patients may present with sudden pain, swelling, and loss of function in the affected area. 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 ruptured tendon, depending on the severity and functional demands of the patient. Accurate coding for spontaneous tendon ruptures is essential for proper reimbursement and to reflect the complexity of the condition.

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 conditions such as tenosynovitis

Audit Risk Factors

  • Inadequate documentation of the specific tendon affected
  • Failure to document associated conditions like tenosynovitis
  • Misclassification of the type of rupture (spontaneous vs. traumatic)
  • Lack of imaging studies to support the diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes including mechanism of injury, physical exam findings, and imaging results.

Common Clinical Scenarios

Patients presenting with sudden onset pain and swelling in the lower leg, often after minimal or no trauma.

Billing Considerations

Ensure documentation reflects the specific tendon involved and any surgical interventions performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Patients recovering from tendon repair surgery requiring rehabilitation services.

Billing Considerations

Document progress and response to therapy to support ongoing treatment needs.

Coding Guidelines

Inclusion Criteria

Use M66.86 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the specific tendon involved and any associated conditions
  • Include details of the clinical presentation and treatment plan to support the diagnosis

Exclusion Criteria

Do NOT use M66.86 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27658CPT Code

Repair of tendon, percutaneous

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 granularity of data for treatment outcomes and reimbursement. M66.86 provides a clear distinction for spontaneous ruptures, which aids in clinical research and quality improvement initiatives.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the granularity of data for treatment outcomes and reimbursement. M66.86 provides a clear distinction for spontaneous ruptures, which aids in clinical research and quality improvement initiatives.

Reimbursement & Billing Impact

reimbursement. M66.86 provides a clear distinction for spontaneous ruptures, which aids in clinical research and quality improvement initiatives.

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 significant trauma, often due to underlying conditions, while traumatic rupture results from a specific injury or accident.