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ICD-10 Guide
DiagnosesPatellar Tendon Rupture

Patellar Tendon Rupture

ICD-10 Coding for Patellar Tendon Rupture(M66.261, M66.262, S76.111)

PRIMARY SPECIALTYOrthopedics
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Patellar Tendon Rupture?
Essential facts and insights about Patellar Tendon Rupture

Key Clinical Considerations:

  • Sudden onset of knee pain, swelling, and inability to extend the knee
  • MRI or ultrasound showing complete rupture of the patellar tendon
  • Tenderness over the patellar tendon, positive 'sag test', and decreased range of motion

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history including mechanism of injury and symptom onset
  • Detailed physical examination findings and imaging results
  • Use of specific terms such as 'complete rupture' or 'partial tear'

Coding Guidelines

Usage Guidelines & Examples

  • Ensure to differentiate between complete and partial ruptures for accurate coding.
  • Common errors include using incorrect laterality or encounter type.

Code Exclusions

Important Exclusions

  • Partial tears of the patellar tendon, tendonitis, and other knee ligament injuries.
  • Alternative codes for knee injuries not involving the patellar tendon.

Related ICD-10 Codes

Primary Codes
S86.012A
Rupture of patellar tendon, right knee, initial encounter
S86.013A
Rupture of patellar tendon, left knee, initial encounter
Differential Codes
S76.111
S76.111
for traumatic injuries with a clear acute event.
S76.112
S76.112
for traumatic injuries with a clear acute event.
M66.261
M66.261
for non-traumatic ruptures.

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Orthopedics

Specialty Applications

  • Athletes, individuals with acute knee injuries, and older adults with degenerative changes.
  • Emergency departments, orthopedic clinics, and rehabilitation centers.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

Documentation requirements?

Include detailed history, physical exam findings, and imaging results.

Billing considerations?

Ensure correct ICD-10 codes are used and document the initial encounter for accurate billing.