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ICD-10 Guide
ICD-10 CodesM66.369

M66.369

Billable

Spontaneous rupture of flexor tendons, unspecified lower leg

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

Code Description

ICD-10 M66.369 is a billable code used to indicate a diagnosis of spontaneous rupture of flexor tendons, unspecified lower leg.

Key Diagnostic Point:

Spontaneous rupture of flexor tendons in the lower leg is a condition characterized by the unexpected tearing of the flexor tendons, which are responsible for bending the toes and ankle. This condition can occur without any apparent trauma or injury, often linked to underlying conditions such as chronic tenosynovitis or degenerative tendon changes. Patients may present with sudden pain, swelling, and loss of function in the affected area. The lower leg's flexor tendons, including the tibialis posterior and flexor digitorum longus, are particularly susceptible to rupture due to their anatomical positioning and the mechanical stresses they endure. Diagnosis typically involves a thorough clinical examination and imaging studies, such as ultrasound or MRI, to confirm the rupture and assess the extent of the injury. Treatment may involve conservative management, such as rest and immobilization, or surgical intervention to repair the ruptured tendon, depending on the severity and functional demands of the patient.

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 co-existing conditions affecting treatment and coding

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture
  • Failure to specify the exact tendon involved
  • Lack of imaging studies to support the diagnosis
  • Inconsistent coding of associated conditions

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging results, and post-operative notes are essential.

Common Clinical Scenarios

Surgical repair of ruptured flexor tendons following spontaneous rupture.

Billing Considerations

Ensure accurate documentation of the surgical technique and any complications.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation plans.

Common Clinical Scenarios

Rehabilitation following tendon repair surgery.

Billing Considerations

Document the patient's progress and any modifications to the rehabilitation plan.

Coding Guidelines

Inclusion Criteria

Use M66.369 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include details about the mechanism of injury and any associated conditions

Exclusion Criteria

Do NOT use M66.369 When
  • Exclude codes for traumatic ruptures unless specified

Related ICD-10 Codes

Related CPT Codes

26301CPT Code

Repair of flexor tendon

Clinical Scenario

Used when a surgical repair is performed following a spontaneous rupture.

Documentation Requirements

Operative report detailing the procedure and any complications.

Specialty Considerations

Orthopedic documentation must specify the tendon repaired and the surgical technique used.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of spontaneous tendon ruptures, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of spontaneous tendon ruptures, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 are the common causes of spontaneous rupture of flexor tendons?

Common causes include chronic tenosynovitis, degenerative tendon changes, and systemic conditions such as diabetes or rheumatoid arthritis.