ICD-10 Coding for Achilles Rupture(S86.01xA, M66.36)
Complete ICD-10-CM coding and documentation guide for Achilles Rupture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Achilles Rupture
S86.01-S86.09Primary Range
Injury of Achilles tendon
This range covers traumatic ruptures of the Achilles tendon, which are common in sports injuries.
Spontaneous rupture of flexor tendons
This range is used for spontaneous ruptures, often related to degenerative conditions or steroid use.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S86.01xA | Strain of Achilles tendon, initial encounter | Use for traumatic ruptures with a clear injury mechanism, such as sports injuries. |
|
| M66.36 | Spontaneous rupture of flexor tendon, lower leg | Use for spontaneous ruptures without a clear traumatic event. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for Achilles rupture
Essential facts and insights about Achilles Rupture
Primary ICD-10-CM Codes for achilles rupture
Decision Criteria
clinical Criteria
- Presence of acute trauma and positive Thompson test
documentation Criteria
- Detailed mechanism of injury and imaging results
Applicable To
- Acute traumatic rupture of Achilles tendon
Excludes
- Spontaneous rupture of Achilles tendon (M66.3)
Clinical Validation Requirements
- Positive Thompson test
- Palpable defect
- MRI confirmation of rupture
Code-Specific Risks
- Confusion with spontaneous rupture codes
- Incorrect laterality documentation
Coding Notes
- Ensure documentation specifies traumatic mechanism and laterality.
M66.36 - Spontaneous rupture of flexor tendon, lower leg
Use for spontaneous ruptures without a clear traumatic event.
Applicable To
- Spontaneous rupture of Achilles tendon
Excludes
- Traumatic rupture of Achilles tendon (S86.01)
Clinical Validation Requirements
- History of tendinopathy
- Absence of acute trauma
- MRI showing degenerative changes
Coding Notes
Document any underlying conditions contributing to the rupture.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of systemic steroids
Z79.52Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Achilles Rupture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S86.01xA.
Impact
Clinical: Ambiguity in treatment plans and follow-up care., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials or delays.
Mitigation Strategy
Always include laterality in clinical notes and coding.
Impact
Reimbursement: Incorrect coding may lead to claim denials or reduced reimbursement., Compliance: Misclassification can result in compliance issues during audits., Data Quality: Inaccurate coding affects clinical data quality and patient records.
Mitigation Strategy
Ensure documentation clearly indicates whether the rupture was due to trauma or occurred spontaneously.
Impact
Using M66.36 without proper documentation of non-traumatic causes.
Mitigation Strategy
Ensure thorough documentation of patient history and absence of trauma.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Achilles Rupture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Achilles Rupture
Use these documentation templates to ensure complete and accurate documentation for Achilles Rupture. These templates include all required elements for proper coding and billing.
Post-operative documentation for Achilles tendon repair
Specialty: Orthopedic SurgeryRequired Elements
- Procedure details
- Laterality
- Surgical findings
- Post-operative plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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