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ICD-10 Guide
ICD-10 CodesM66.88

M66.88

Billable

Spontaneous rupture of other tendons, other sites

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

Code Description

ICD-10 M66.88 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, other sites.

Key Diagnostic Point:

Spontaneous rupture of tendons is a condition characterized by the sudden tearing of a tendon without any significant trauma or injury. This can occur in various tendons throughout the body, particularly in individuals with underlying conditions such as tenosynovitis, which is the inflammation of the synovial sheath surrounding a tendon. The rupture may lead to pain, swelling, and loss of function in the affected area. Common sites for spontaneous tendon ruptures include the Achilles tendon, biceps tendon, and other less frequently involved tendons. The condition may be associated with chronic degenerative changes, systemic diseases, or metabolic disorders. Diagnosis typically involves a thorough clinical examination, imaging studies such as ultrasound or MRI, and sometimes diagnostic injections. Treatment options may include conservative management with rest and physical therapy, or surgical intervention to repair the ruptured tendon, depending on the severity and location of the rupture. Accurate coding is essential for proper reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of tendon sites affected
  • Differentiation from traumatic tendon ruptures
  • Need for detailed documentation of underlying conditions
  • Potential for co-existing conditions affecting treatment

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture
  • Failure to specify the tendon involved
  • Lack of evidence for underlying conditions contributing to the rupture
  • Inconsistent coding of surgical repairs

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed operative reports, imaging results, and clinical notes outlining the mechanism of injury and treatment plan.

Common Clinical Scenarios

Patients presenting with sudden onset pain and swelling in the shoulder or ankle, often with a history of chronic tendonitis.

Billing Considerations

Ensure that all relevant imaging studies are documented to support the diagnosis and treatment plan.

Rheumatology

Documentation Requirements

Comprehensive patient history including systemic conditions, lab results, and treatment history.

Common Clinical Scenarios

Patients with autoimmune disorders presenting with tendon ruptures due to underlying inflammation.

Billing Considerations

Document any systemic conditions that may contribute to tendon weakness or rupture.

Coding Guidelines

Inclusion Criteria

Use M66.88 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the spontaneous nature of the rupture and any associated conditions

Exclusion Criteria

Do NOT use M66.88 When
  • Exclude traumatic ruptures and differentiate from other tendon disorders

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Repair of ruptured tendon, shoulder

Clinical Scenario

Used when a spontaneous rupture of the biceps tendon is surgically repaired.

Documentation Requirements

Operative report detailing the procedure and indication for surgery.

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 spontaneous tendon ruptures, improving the accuracy of claims and facilitating better tracking of these conditions in clinical practice.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spontaneous tendon ruptures, improving the accuracy of claims and facilitating better tracking of these conditions in clinical practice.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of spontaneous tendon ruptures, improving the accuracy of claims and facilitating better tracking of these conditions in clinical practice.

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 event.