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ICD-10 Guide
ICD-10 CodesM66.261

M66.261

Billable

Spontaneous rupture of extensor tendons, right lower leg

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

Code Description

ICD-10 M66.261 is a billable code used to indicate a diagnosis of spontaneous rupture of extensor tendons, right lower leg.

Key Diagnostic Point:

Spontaneous rupture of extensor tendons in the right lower leg is a condition characterized by the unexpected tearing of the extensor tendons, which are responsible for extending the toes and foot. This injury can occur due to various factors, including underlying degenerative changes, inflammatory conditions, or acute trauma. Patients may present with sudden pain, swelling, and loss of function in the affected area. The diagnosis is typically confirmed through clinical examination and imaging studies, such as ultrasound or MRI, which can visualize the extent of the tendon damage. Treatment options may include conservative management with rest and immobilization, or surgical intervention to repair the ruptured tendon, depending on the severity of the injury and the patient's functional needs. Rehabilitation is often necessary to restore strength and mobility post-repair. Accurate coding is essential for proper reimbursement and tracking of treatment outcomes.

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 injury
  • Differentiation from other tendon injuries and conditions
  • Potential for surgical intervention and associated coding

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the laterality of the injury
  • Misclassification of the type of tendon injury
  • Lack of supporting imaging documentation

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with acute pain and swelling in the lower leg, often after a fall or sports injury.

Billing Considerations

Ensure clear documentation of the surgical approach and any complications encountered during the procedure.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Patients recovering from tendon repair surgery requiring physical therapy.

Billing Considerations

Document progress notes that reflect improvements in strength and range of motion.

Coding Guidelines

Inclusion Criteria

Use M66.261 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the injury's nature, laterality, and any associated conditions

Exclusion Criteria

Do NOT use M66.261 When
  • Exclude codes for traumatic ruptures unless specified

Related ICD-10 Codes

Related CPT Codes

27301CPT Code

Repair of tendon, extensor, lower leg

Clinical Scenario

Used when surgical repair is performed for a spontaneous rupture.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure clear documentation of the surgical approach and any complications.

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. M66.261 provides a clear distinction between spontaneous and traumatic ruptures, aiding in accurate clinical documentation.

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. M66.261 provides a clear distinction between spontaneous and traumatic ruptures, aiding in accurate clinical documentation.

Reimbursement & Billing Impact

reimbursement. M66.261 provides a clear distinction between spontaneous and traumatic ruptures, aiding in accurate clinical documentation.

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 rupture of tendons?

Spontaneous rupture occurs without a specific traumatic event, often due to underlying conditions, while traumatic rupture is a direct result of an injury or accident.