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ICD-10 Guide
ICD-10 CodesM66.322

M66.322

Billable

Spontaneous rupture of flexor tendons, left upper arm

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

Code Description

ICD-10 M66.322 is a billable code used to indicate a diagnosis of spontaneous rupture of flexor tendons, left upper arm.

Key Diagnostic Point:

Spontaneous rupture of flexor tendons in the left upper arm is a condition characterized by the unexpected tearing of the flexor tendons, which are responsible for bending the fingers and wrist. This injury can occur without any preceding trauma or significant strain, often seen in individuals with underlying conditions such as rheumatoid arthritis or chronic tenosynovitis. The rupture may lead to loss of function, pain, and swelling in the affected area. Diagnosis typically involves a thorough physical examination, imaging studies such as ultrasound or MRI, and assessment of the patient's medical history. Treatment options may include surgical repair of the tendon, physical therapy, and pain management strategies. Early intervention is crucial to restore function and prevent complications such as tendon retraction or chronic pain syndromes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures.
  • Understanding the anatomical location and specific tendon involved.
  • Identifying associated conditions like tenosynovitis or arthritis.
  • Documenting the severity and functional impact of the rupture.

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture.
  • Failure to specify laterality (left vs. right).
  • Lack of supporting evidence for associated conditions.
  • Improper coding of surgical procedures related to the rupture.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed operative reports, imaging results, and pre/post-operative assessments.

Common Clinical Scenarios

Patients presenting with acute pain and loss of function in the hand or wrist, often following a history of chronic tendon issues.

Billing Considerations

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

Rheumatology

Documentation Requirements

Comprehensive patient history, including previous joint issues and systemic symptoms.

Common Clinical Scenarios

Patients with autoimmune disorders presenting with tendon ruptures as a complication of their underlying condition.

Billing Considerations

Document the relationship between systemic disease and tendon integrity.

Coding Guidelines

Inclusion Criteria

Use M66.322 When
  • According to ICD
  • 10 guidelines, M66
  • 322 should be used when the rupture is spontaneous and specifically involves the flexor tendons of the left upper arm
  • Coders must ensure that the documentation supports the diagnosis and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use M66.322 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

26301CPT Code

Repair of flexor tendon

Clinical Scenario

Used when surgical repair is performed for spontaneous tendon rupture.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the specific tendon repaired 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 accuracy of data collection and reimbursement processes. M66.322 provides a clear distinction between spontaneous and traumatic ruptures, which is crucial for 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 data collection and reimbursement processes. M66.322 provides a clear distinction between spontaneous and traumatic ruptures, which is crucial for treatment planning and outcome tracking.

Reimbursement & Billing Impact

reimbursement processes. M66.322 provides a clear distinction between spontaneous and traumatic ruptures, which is crucial for treatment planning and outcome tracking.

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 any identifiable trauma or injury, often due to underlying conditions, while traumatic rupture is a direct result of an injury or excessive force applied to the tendon.