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ICD-10 Guide
ICD-10 CodesM66.269

M66.269

Billable

Spontaneous rupture of extensor tendons, unspecified lower leg

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

Code Description

ICD-10 M66.269 is a billable code used to indicate a diagnosis of spontaneous rupture of extensor tendons, unspecified lower leg.

Key Diagnostic Point:

Spontaneous rupture of extensor tendons in the lower leg is a condition characterized by the unexpected tearing of the extensor tendons, which are responsible for extending the toes and ankle. This injury can occur due to various factors, including overuse, degenerative changes, 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, such as rest and physical therapy, or surgical intervention to repair the ruptured tendon. Surgical repair often involves suturing the tendon ends together or reconstructing the tendon using grafts. The prognosis varies depending on the severity of the rupture and the timeliness of treatment, with early intervention generally leading to better 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 mechanism of injury
  • Differentiation from other tendon injuries or conditions
  • Potential for surgical versus non-surgical treatment options

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the exact tendon involved
  • Lack of imaging studies to support the diagnosis
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging results, and post-operative care plans.

Common Clinical Scenarios

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

Billing Considerations

Ensure that the surgical approach and any graft materials used are clearly documented.

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 and response to therapy to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use M66.269 When
  • According to ICD
  • 10 guidelines, M66
  • 269 should be used when the specific extensor tendon is not identified
  • Coders must ensure that the documentation supports the diagnosis of spontaneous rupture and that other potential causes of tendon injury are ruled out

Exclusion Criteria

Do NOT use M66.269 When
No specific exclusions found.

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 document the specific tendon repaired and any grafts used.

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 claims and facilitating better patient management. M66.269 provides a clear designation for spontaneous ruptures, which aids in treatment planning and outcome tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the accuracy of claims and facilitating better patient management. M66.269 provides a clear designation for spontaneous ruptures, which aids in treatment planning and outcome tracking.

Reimbursement & Billing Impact

reimbursement and to avoid claim denials.

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 degenerative changes in the tendon, chronic overuse, or sudden increases in activity levels.