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ICD-10 Guide
ICD-10 CodesM66.251

M66.251

Billable

Spontaneous rupture of extensor tendons, right thigh

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

Code Description

ICD-10 M66.251 is a billable code used to indicate a diagnosis of spontaneous rupture of extensor tendons, right thigh.

Key Diagnostic Point:

Spontaneous rupture of extensor tendons in the right thigh is a condition characterized by the unexpected tearing of the extensor tendons, which are responsible for extending the knee and stabilizing the leg during movement. This condition can occur due to various factors, including underlying degenerative changes, chronic tenosynovitis, or acute trauma. Patients may present with sudden pain, swelling, and loss of function in the affected area. The diagnosis is typically confirmed through physical examination and imaging studies such as MRI or ultrasound, which can visualize the extent of the tendon damage. Treatment options may include conservative management with rest and physical therapy or surgical intervention to repair the ruptured tendon. Surgical repair aims to restore function and alleviate pain, and rehabilitation is crucial for optimal recovery. Accurate coding is essential for proper reimbursement and tracking of treatment outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures
  • Identifying the specific tendon involved
  • Understanding the implications of associated conditions like tenosynovitis
  • Documenting the laterality of the condition accurately

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture
  • Failure to specify the laterality of the injury
  • Lack of imaging studies to support the diagnosis
  • Misclassification of the type of tendon involved

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with acute knee pain and swelling after a fall or sports injury.

Billing Considerations

Ensure that the documentation clearly states the spontaneous nature of the rupture and any associated conditions.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery for tendon repair.

Billing Considerations

Document progress and response to therapy to support ongoing treatment coding.

Coding Guidelines

Inclusion Criteria

Use M66.251 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant history of tenosynovitis or other conditions that may contribute to the rupture

Exclusion Criteria

Do NOT use M66.251 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27301CPT Code

Repair of tendon, extensor, thigh

Clinical Scenario

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

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure that the surgical notes clearly indicate the nature of the rupture.

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, improving the granularity of data for treatment outcomes and reimbursement. M66.251 provides a clear distinction between spontaneous and traumatic ruptures, which is crucial for accurate coding.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the granularity of data for treatment outcomes and reimbursement. M66.251 provides a clear distinction between spontaneous and traumatic ruptures, which is crucial for accurate coding.

Reimbursement & Billing Impact

reimbursement. M66.251 provides a clear distinction between spontaneous and traumatic ruptures, which is crucial for accurate coding.

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 a specific traumatic event, often due to underlying conditions, while traumatic rupture is a direct result of an injury or accident.