Spontaneous rupture of other tendons, unspecified lower leg
ICD-10 M66.869 is a billable code used to indicate a diagnosis of spontaneous rupture of other tendons, unspecified lower leg.
Spontaneous rupture of tendons in the lower leg can occur due to various factors, including underlying degenerative conditions, acute trauma, or chronic overuse. This condition is characterized by the sudden tearing of tendons, which may lead to significant pain, swelling, and functional impairment. The lower leg comprises several tendons, including those associated with the Achilles, peroneal, and tibialis muscles. The spontaneous rupture of these tendons can result from conditions such as tenosynovitis, where inflammation of the tendon sheath leads to weakening and eventual rupture. Diagnosis typically involves a thorough clinical examination, imaging studies such as ultrasound or MRI, and assessment of the patient's history. Treatment may vary from conservative management, including rest and physical therapy, to surgical intervention for repair or reconstruction of the ruptured tendon. Accurate coding is essential for proper reimbursement and to reflect the complexity of the patient's condition.
Detailed clinical notes, imaging results, and treatment plans must be documented.
Patients presenting with acute pain and swelling in the lower leg, often after a sudden increase in activity.
Documentation should clearly state the mechanism of injury and any pre-existing conditions that may have contributed to the rupture.
Comprehensive assessment of functional limitations and rehabilitation goals.
Patients requiring rehabilitation post-surgery or conservative management for tendon ruptures.
Focus on documenting the patient's functional status and progress throughout rehabilitation.
Used when surgical repair is performed for spontaneous tendon rupture.
Operative report detailing the procedure and findings.
Orthopedic surgeons must document the specific tendon repaired and the surgical technique used.
Spontaneous tendon rupture occurs without a specific traumatic event, often due to underlying degenerative conditions, while traumatic rupture is the result of an acute injury or excessive force applied to the tendon.
