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ICD-10 Guide
ICD-10 CodesM66.15

M66.15

Billable

Rupture of synovium, hip

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

Code Description

ICD-10 M66.15 is a billable code used to indicate a diagnosis of rupture of synovium, hip.

Key Diagnostic Point:

Rupture of the synovium in the hip joint is a condition characterized by the tearing of the synovial membrane, which lines the joint capsule and produces synovial fluid. This condition can result from acute trauma, chronic inflammatory conditions, or degenerative diseases affecting the hip joint. The synovium plays a crucial role in joint lubrication and nutrition, and its rupture can lead to pain, swelling, and reduced range of motion. Patients may present with symptoms such as hip pain, swelling, and difficulty bearing weight. Diagnosis typically involves a thorough clinical examination, imaging studies such as MRI or ultrasound, and sometimes arthroscopy to visualize the joint. Treatment options may include conservative management with rest, ice, and anti-inflammatory medications, or surgical intervention to repair the synovium if conservative measures fail. Understanding the underlying causes, such as tenosynovitis or tendon ruptures, is essential for effective management and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between acute and chronic conditions
  • Understanding associated conditions like tenosynovitis
  • Need for precise documentation of symptoms and imaging results
  • Variability in treatment approaches and their documentation

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify acute vs. chronic rupture
  • Lack of imaging results in the medical record
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on the mechanism of injury, physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Acute hip injuries from falls, chronic hip pain in athletes, and post-surgical complications.

Billing Considerations

Ensure clarity in distinguishing between synovial rupture and other hip pathologies.

Rheumatology

Documentation Requirements

Comprehensive history of joint symptoms, laboratory results indicating inflammatory markers, and treatment response.

Common Clinical Scenarios

Patients with rheumatoid arthritis experiencing hip joint issues and those with gout-related synovitis.

Billing Considerations

Documenting the underlying rheumatologic condition is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M66.15 When
  • According to ICD
  • 10 coding guidelines, M66
  • 15 should be used when the rupture of the synovium is confirmed through clinical evaluation and imaging
  • It is important to document the specific site and nature of the rupture, as well as any associated conditions

Exclusion Criteria

Do NOT use M66.15 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

29862CPT Code

Arthroscopy, hip, surgical

Clinical Scenario

Used when surgical intervention is required for a ruptured synovium.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like M66.15, improving the accuracy of claims and facilitating better patient care through detailed documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like M66.15, improving the accuracy of claims and facilitating better patient care through detailed documentation.

Reimbursement & Billing Impact

reimbursement.

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 are the common causes of synovial rupture in the hip?

Common causes include acute trauma, chronic inflammatory conditions such as rheumatoid arthritis, and degenerative changes associated with aging.