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ICD-10 Guide
ICD-10 CodesM66.30

M66.30

Billable

Spontaneous rupture of flexor tendons, unspecified site

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

Code Description

ICD-10 M66.30 is a billable code used to indicate a diagnosis of spontaneous rupture of flexor tendons, unspecified site.

Key Diagnostic Point:

Spontaneous rupture of flexor tendons refers to the unexpected tearing of the tendons that flex the fingers or toes, occurring without any apparent external trauma. This condition can arise due to various factors, including chronic inflammation, degenerative changes, or underlying systemic diseases such as rheumatoid arthritis or diabetes. The flexor tendons are crucial for hand function, allowing for the bending of fingers. When these tendons rupture, patients may experience significant pain, loss of function, and inability to flex the affected digit. Diagnosis typically involves a thorough clinical examination and may be supported by imaging studies such as ultrasound or MRI to assess the extent of the rupture. Treatment often requires surgical intervention to repair the tendon, followed by rehabilitation to restore function. The unspecified site indicates that the exact location of the rupture is not documented, which can complicate treatment planning and coding accuracy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified site may lead to ambiguity in treatment and coding.
  • Differentiating between spontaneous and traumatic ruptures.
  • Potential for co-existing conditions affecting tendon health.
  • Variability in surgical repair techniques and documentation.

Audit Risk Factors

  • Lack of specificity in documentation regarding the site of rupture.
  • Inadequate clinical rationale for the diagnosis.
  • Failure to document co-existing conditions that may affect treatment.
  • Insufficient details on the surgical procedure performed.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, including the site of rupture, surgical technique, and post-operative care.

Common Clinical Scenarios

Patients presenting with acute pain and loss of function in the hand, often following a history of chronic tendonitis.

Billing Considerations

Ensure that all surgical interventions are documented clearly to support the coding of M66.30.

Rheumatology

Documentation Requirements

Comprehensive patient history, including any underlying rheumatologic conditions that may predispose to tendon rupture.

Common Clinical Scenarios

Patients with rheumatoid arthritis experiencing sudden loss of finger function.

Billing Considerations

Documenting the relationship between systemic disease and tendon health is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M66.30 When
  • According to ICD
  • 10 coding guidelines, M66
  • 30 should be used when the documentation specifies a spontaneous rupture of flexor tendons without detailing the site
  • Coders must ensure that the medical record supports the diagnosis and that all relevant clinical information is included

Exclusion Criteria

Do NOT use M66.30 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

26301CPT Code

Repair of flexor tendon

Clinical Scenario

Used when a surgical repair is performed for a spontaneous rupture of the flexor tendon.

Documentation Requirements

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

Specialty Considerations

Orthopedic surgeons must ensure that the surgical technique is clearly 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 ruptures, improving the accuracy of data collection and reimbursement processes. M66.30 provides a mechanism to capture spontaneous ruptures that may not have been adequately represented in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon ruptures, improving the accuracy of data collection and reimbursement processes. M66.30 provides a mechanism to capture spontaneous ruptures that may not have been adequately represented in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. M66.30 provides a mechanism to capture spontaneous ruptures that may not have been adequately represented in ICD-9.

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 M66.30 and M66.31?

M66.30 is used for spontaneous ruptures of flexor tendons when the site is unspecified, while M66.31 is specifically for ruptures occurring in the right hand.