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ICD-10 Guide
ICD-10 CodesM66.259

M66.259

Billable

Spontaneous rupture of extensor tendons, unspecified thigh

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

Code Description

ICD-10 M66.259 is a billable code used to indicate a diagnosis of spontaneous rupture of extensor tendons, unspecified thigh.

Key Diagnostic Point:

Spontaneous rupture of extensor tendons in the 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 without any apparent trauma or injury, often seen in individuals with underlying conditions such as rheumatoid arthritis or chronic tenosynovitis. The rupture may lead to significant functional impairment, pain, and swelling in the thigh region. Diagnosis typically involves a thorough clinical examination, imaging studies such as MRI or ultrasound, and assessment of the patient's history. Treatment options may include conservative management with rest and physical therapy or surgical intervention to repair the ruptured tendon. The prognosis varies depending on the severity of the rupture and the timeliness of treatment. Accurate coding is essential for proper reimbursement and to reflect the complexity of the condition in medical records.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of tendon rupture
  • Need for precise documentation of the location and extent of the rupture
  • Differentiation from other tendon injuries and conditions
  • Potential for co-existing conditions affecting treatment and coding

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the side of the rupture
  • Lack of imaging studies to support the diagnosis
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on the patient's history, physical examination findings, imaging results, and treatment plan.

Common Clinical Scenarios

Patients presenting with knee pain and swelling, particularly in older adults or those with chronic inflammatory conditions.

Billing Considerations

Ensure clear documentation of the extent of the rupture and any surgical interventions performed.

Rheumatology

Documentation Requirements

Comprehensive assessment of underlying rheumatologic conditions that may contribute to tendon rupture.

Common Clinical Scenarios

Patients with rheumatoid arthritis experiencing sudden onset of thigh pain.

Billing Considerations

Document any systemic symptoms or laboratory findings that may indicate an underlying condition.

Coding Guidelines

Inclusion Criteria

Use M66.259 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the code reflects the specific clinical scenario
  • Include any relevant co
  • morbidities and document the treatment approach

Exclusion Criteria

Do NOT use M66.259 When
  • Exclude conditions that are not spontaneous ruptures

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.

Documentation Requirements

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

Specialty Considerations

Orthopedic surgeons should ensure that the surgical approach and technique are well documented.

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 accuracy of medical records and reimbursement processes. M66.259 provides a clear classification for spontaneous ruptures, which aids in clinical research and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the accuracy of medical records and reimbursement processes. M66.259 provides a clear classification for spontaneous ruptures, which aids in clinical research and treatment outcomes.

Reimbursement & Billing Impact

reimbursement processes. M66.259 provides a clear classification for spontaneous ruptures, which aids in clinical research and treatment outcomes.

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?

Spontaneous ruptures are often associated with underlying conditions such as chronic inflammation, degenerative changes, or systemic diseases like rheumatoid arthritis.