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ICD-10 Guide
ICD-10 CodesM66.80

M66.80

Billable

Spontaneous rupture of other tendons, unspecified site

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

Code Description

ICD-10 M66.80 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, unspecified site.

Key Diagnostic Point:

Spontaneous rupture of tendons is a condition characterized by the unexpected tearing of tendon fibers without any significant trauma or injury. This can occur in various tendons throughout the body, often associated with underlying conditions such as tenosynovitis, which is inflammation of the synovial sheath surrounding the tendon. The rupture may lead to pain, swelling, and loss of function in the affected area. Common sites for tendon ruptures include the shoulder, ankle, and wrist, although M66.80 is used when the specific site is not identified. The condition may be exacerbated by chronic overuse, systemic diseases, or degenerative changes in the tendon. Diagnosis typically involves clinical evaluation and imaging studies, such as ultrasound or MRI, to confirm the rupture and assess the extent of damage. Treatment may vary from conservative management, including rest and physical therapy, to surgical intervention for repair, especially in cases where the rupture significantly impairs function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified site can lead to ambiguity in documentation.
  • Differentiating between spontaneous and traumatic ruptures.
  • Need for comprehensive clinical documentation to support the diagnosis.
  • Potential overlap with other tendon-related codes.

Audit Risk Factors

  • Insufficient documentation of the spontaneous nature of the rupture.
  • Lack of imaging studies to support the diagnosis.
  • Inconsistent terminology used in clinical notes.
  • Failure to document the patient's history of tendon issues.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with sudden onset pain and swelling in joints, particularly after repetitive use.

Billing Considerations

Ensure clarity in distinguishing between spontaneous and traumatic ruptures.

Rheumatology

Documentation Requirements

Comprehensive history of systemic conditions that may contribute to tendon degeneration.

Common Clinical Scenarios

Patients with autoimmune disorders presenting with tendon pain and swelling.

Billing Considerations

Document any underlying rheumatologic conditions that may predispose to tendon rupture.

Coding Guidelines

Inclusion Criteria

Use M66.80 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • 80 should be used when the specific tendon site is not documented
  • Ensure to check for any additional codes that may provide more specificity

Exclusion Criteria

Do NOT use M66.80 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

29827CPT Code

Arthroscopy, shoulder, surgical; with repair of SLAP lesion

Clinical Scenario

Used when surgical intervention is required for a spontaneous rupture of the shoulder tendon.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic documentation must clearly indicate the diagnosis and surgical necessity.

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, including spontaneous ruptures. M66.80 provides a means to capture cases where the specific tendon is not identified, but it requires careful documentation to avoid misclassification.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon injuries, including spontaneous ruptures. M66.80 provides a means to capture cases where the specific tendon is not identified, but it requires careful documentation to avoid misclassification.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of tendon injuries, including spontaneous ruptures. M66.80 provides a means to capture cases where the specific tendon is not identified, but it requires careful documentation to avoid misclassification.

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 significant trauma, often due to underlying conditions, while traumatic rupture is a direct result of an injury or accident.