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v1.0.0
ICD-10 Guide
ICD-10 CodesM66.862

M66.862

Billable

Spontaneous rupture of other tendons, left lower leg

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

Code Description

ICD-10 M66.862 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, left lower leg.

Key Diagnostic Point:

Spontaneous rupture of tendons in the left lower leg is a condition characterized by the unexpected tearing of tendons without any significant trauma or injury. This condition can occur due to various factors, including chronic degeneration of the tendon, inflammatory processes, or underlying systemic diseases. The left lower leg is home to several important tendons, including those associated with the gastrocnemius, soleus, and tibialis posterior muscles. Symptoms typically include sudden pain, swelling, and loss of function in the affected area. Diagnosis is often confirmed through physical examination and imaging studies such as ultrasound or MRI. Treatment may involve conservative management, including rest, ice, compression, and elevation (RICE), or surgical intervention to repair the ruptured tendon, depending on the severity and functional demands of the patient. Rehabilitation is crucial for restoring strength and mobility post-repair.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures
  • Identifying the specific tendon involved
  • Documenting the clinical context and underlying conditions
  • Understanding the implications of surgical versus conservative management

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture
  • Failure to specify the tendon involved
  • Lack of imaging studies to support the 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

Patients presenting with sudden onset pain in the left lower leg, often after minimal activity.

Billing Considerations

Ensure that the documentation clearly states the spontaneous nature of the rupture and any relevant comorbidities.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive rehabilitation plans and progress notes post-surgery.

Common Clinical Scenarios

Patients undergoing rehabilitation after tendon repair surgery.

Billing Considerations

Document functional limitations and goals for therapy to support coding for rehabilitation services.

Coding Guidelines

Inclusion Criteria

Use M66.862 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant history of tendon disorders or systemic diseases that may contribute to the rupture

Exclusion Criteria

Do NOT use M66.862 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27658CPT Code

Repair of ruptured tendon

Clinical Scenario

Used when surgical repair is performed for spontaneous tendon rupture.

Documentation Requirements

Operative report detailing the procedure and findings.

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 ruptures, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon ruptures, improving the accuracy of data collection 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 significant trauma, often due to underlying degeneration, while traumatic rupture results from a specific injury or event.