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ICD-10 Guide
ICD-10 CodesM66.219

M66.219

Billable

Spontaneous rupture of extensor tendons, unspecified shoulder

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

Code Description

ICD-10 M66.219 is a billable code used to indicate a diagnosis of spontaneous rupture of extensor tendons, unspecified shoulder.

Key Diagnostic Point:

Spontaneous rupture of extensor tendons in the shoulder is a condition characterized by the unexpected tearing of the extensor tendons, which are responsible for extending the arm and fingers. This condition can occur without any apparent trauma or injury, often in individuals with underlying tendon degeneration or inflammatory conditions. The extensor tendons are located in the shoulder region and are crucial for the proper functioning of the upper limb. Symptoms may include sudden pain, swelling, and loss of function in the affected shoulder. Diagnosis typically involves a physical examination and imaging studies such as MRI or ultrasound to confirm the rupture. Treatment options may vary from conservative management, including rest and physical therapy, to surgical intervention for tendon repair or reconstruction, depending on the severity of the rupture and the patient's overall health status. Understanding the underlying causes, such as tenosynovitis or other synovial disorders, is essential for effective management and prevention of recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of tendon rupture
  • Need for precise documentation of symptoms and imaging findings
  • Differentiation from other shoulder conditions such as rotator cuff tears
  • Potential for concurrent diagnoses that may complicate coding

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture
  • Failure to document associated symptoms or imaging results
  • Misclassification of the condition as traumatic rather than spontaneous
  • Lack of clarity in treatment plans and follow-up care

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging reports, and pre-operative assessments are essential.

Common Clinical Scenarios

Patients presenting with shoulder pain and functional limitations, often after a sudden onset of symptoms.

Billing Considerations

Documentation must clearly differentiate between spontaneous and traumatic ruptures to ensure accurate coding.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluations including functional assessments and treatment plans.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery or conservative management for tendon ruptures.

Billing Considerations

Focus on documenting progress and functional outcomes to support the need for ongoing therapy.

Coding Guidelines

Inclusion Criteria

Use M66.219 When
  • According to ICD
  • 10 coding guidelines, M66
  • 219 should be used when the spontaneous rupture of extensor tendons is confirmed and no specific shoulder tendon is identified
  • It is important to document the clinical findings and any imaging results that support the diagnosis

Exclusion Criteria

Do NOT use M66.219 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Repair of ruptured tendon, shoulder

Clinical Scenario

Used when surgical repair is performed for spontaneous rupture of extensor tendons.

Documentation Requirements

Operative report detailing the procedure, findings, and post-operative care.

Specialty Considerations

Orthopedic surgeons must document the extent of the rupture and the surgical approach taken.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of tendon injuries, including spontaneous ruptures, which enhances the accuracy of patient records and facilitates better treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon injuries, including spontaneous ruptures, which enhances the accuracy of patient records and facilitates better treatment planning.

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 is the primary cause of spontaneous rupture of extensor tendons?

The primary cause is often degenerative changes in the tendon due to age, chronic inflammation, or systemic diseases that weaken tendon integrity.