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ICD-10 Guide
DiagnosesRupture Of Achilles Tendon

Rupture Of Achilles Tendon

ICD-10 Coding for Rupture of Achilles Tendon(S86.012A, M66.361)

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

Diagnosis Overview

What is Rupture Of Achilles Tendon?
Essential facts and insights about Rupture of Achilles Tendon

Key Clinical Considerations:

  • Sudden pain in the back of the ankle or calf
  • Swelling and bruising around the heel
  • Inability to stand on tiptoe or push off the foot
  • Positive Thompson test

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history of acute injury or chronic degeneration
  • Physical exam findings including range of motion and strength
  • Imaging results (e.g., MRI or ultrasound) confirming rupture
  • Specific terminology such as 'complete rupture' or 'partial tear'

Coding Guidelines

Usage Guidelines & Examples

  • Usage guidelines: Use specific codes based on laterality and encounter type.
  • Common errors: Failing to document the mechanism of injury or misclassifying the type of rupture.

Code Exclusions

Important Exclusions

  • Achilles tendonitis, partial tears, or other tendon injuries
  • Alternative codes for related conditions such as ankle sprains

Related ICD-10 Codes

Primary Codes
S86.001A
Rupture of right Achilles tendon, initial encounter
S86.002A
Rupture of left Achilles tendon, initial encounter
Ancillary Codes
Z79.2
Differential Codes
M66.361
S86.012A

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Orthopedics

Specialty Applications

  • Athletes, older adults, individuals with a history of tendonitis
  • Emergency departments, orthopedic clinics, 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 patient history, physical exam findings, and imaging results.

Billing considerations?

Ensure correct ICD-10 codes are used and document the encounter type (initial, subsequent, sequela).