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ICD-10 Guide
ICD-10 CodesM66.851

M66.851

Billable

Spontaneous rupture of other tendons, right thigh

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

Code Description

ICD-10 M66.851 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, right thigh.

Key Diagnostic Point:

Spontaneous rupture of tendons in the right thigh can occur due to various factors, including underlying conditions such as tenosynovitis, degenerative changes, or systemic diseases that weaken the tendon structure. This condition is characterized by the sudden onset of pain, swelling, and functional impairment in the affected area. The right thigh is home to several important tendons, including those associated with the quadriceps and hamstring muscles. A spontaneous rupture may present without a clear traumatic event, making diagnosis challenging. Clinicians often rely on imaging studies, such as MRI or ultrasound, to confirm the diagnosis and assess the extent of the injury. Treatment may involve conservative management, including rest and physical therapy, or surgical intervention to repair the ruptured tendon, depending on the severity of the rupture and the patient's functional needs. Accurate coding is essential for proper reimbursement and to reflect the complexity of the condition and its management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between spontaneous and traumatic ruptures
  • Identifying the specific tendon involved
  • Understanding associated conditions like tenosynovitis
  • Documenting the clinical presentation accurately

Audit Risk Factors

  • Inadequate documentation of the spontaneous nature of the rupture
  • Failure to specify the tendon involved
  • Lack of imaging studies to support the diagnosis
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on the mechanism of injury, imaging results, and treatment plan.

Common Clinical Scenarios

Patients presenting with sudden thigh pain, swelling, and functional limitations.

Billing Considerations

Ensure that the documentation clearly states the spontaneous nature of the rupture and any associated conditions.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Patients recovering from tendon repair or those undergoing conservative management.

Billing Considerations

Document the patient's progress and response to therapy to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use M66.851 When
  • Follow official coding guidelines for tendon injuries, ensuring accurate documentation of the spontaneous rupture and the specific tendon involved
  • Include any relevant comorbidities that may affect treatment

Exclusion Criteria

Do NOT use M66.851 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 spontaneous tendon rupture.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic documentation must clearly link the procedure to the diagnosis.

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 granularity of data for treatment and outcomes. M66.851 provides a clear distinction for spontaneous ruptures, which aids in clinical research and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of tendon injuries, improving the granularity of data for treatment and outcomes. M66.851 provides a clear distinction for spontaneous ruptures, which aids in clinical research and reimbursement.

Reimbursement & Billing Impact

reimbursement.

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 a specific traumatic event, often due to underlying conditions, while traumatic rupture is the result of a specific injury or accident.