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ICD-10 Guide
ICD-10 CodesM66.85

M66.85

Billable

Spontaneous rupture of other tendons, thigh

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

Code Description

ICD-10 M66.85 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, thigh.

Key Diagnostic Point:

Spontaneous rupture of tendons in the thigh region can occur due to various factors, including underlying degenerative changes, inflammatory conditions, or acute trauma. This condition is characterized by the sudden tearing of the tendon fibers, which may lead to significant pain, swelling, and functional impairment. Common tendons affected include the quadriceps tendon and hamstring tendons. Patients may present with acute onset of pain, a palpable defect in the tendon, and difficulty in movement. Diagnostic imaging, such as ultrasound or MRI, may be utilized to confirm the diagnosis and assess the extent of the rupture. Treatment often involves conservative management, including rest, ice, compression, and elevation (RICE), followed by physical therapy. In cases of complete rupture or significant functional impairment, surgical intervention may be necessary to repair the tendon. Post-surgical rehabilitation is crucial for restoring function and preventing re-injury. Accurate coding for spontaneous tendon ruptures is essential for appropriate reimbursement and tracking of healthcare outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of tendon ruptures
  • Need for precise documentation of the specific tendon involved
  • Differentiation from other tendon injuries and conditions
  • Potential for co-existing conditions that may complicate coding

Audit Risk Factors

  • Inadequate documentation of the specific tendon involved
  • Failure to document the mechanism of injury
  • Lack of imaging studies to support the diagnosis
  • Inconsistent coding of co-existing conditions

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging results, and pre-operative assessments are essential.

Common Clinical Scenarios

Patients presenting with acute thigh pain following a sports injury or fall.

Billing Considerations

Ensure that the specific tendon involved is clearly documented to avoid coding errors.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluation notes, functional assessments, and treatment plans.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery for tendon repair.

Billing Considerations

Document the patient's functional limitations and progress to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use M66.85 When
  • According to ICD
  • 10 coding guidelines, M66
  • 85 should be used when there is clear documentation of a spontaneous rupture of a tendon in the thigh
  • It is important to ensure that the documentation specifies the tendon involved and any associated conditions

Exclusion Criteria

Do NOT use M66.85 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27301CPT Code

Repair of tendon, thigh

Clinical Scenario

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

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure accurate coding based on the specific tendon repaired.

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. M66.85 provides a clear designation for spontaneous ruptures, facilitating better tracking of treatment outcomes.

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. M66.85 provides a clear designation for spontaneous ruptures, facilitating better tracking of treatment outcomes.

Reimbursement & Billing Impact

reimbursement processes. M66.85 provides a clear designation for spontaneous ruptures, facilitating better tracking of treatment outcomes.

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 documentation is needed to support the use of M66.85?

Documentation should include a detailed clinical history, physical examination findings, imaging results confirming the rupture, and any treatment plans or surgical notes.