ICD-10 Coding for Achilles Tendon Injury(S86.012A, M66.372)
Complete ICD-10-CM coding and documentation guide for Achilles Tendon Injury. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Achilles Tendon Injury
S86.0-S86.01Primary Range
Injury of Achilles tendon
This range includes codes for acute injuries to the Achilles tendon, such as ruptures and strains.
Spontaneous rupture of tendon
This range is used for chronic or spontaneous ruptures of the Achilles tendon without acute trauma.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S86.012A | Strain of left Achilles tendon, initial encounter | Use for acute traumatic rupture of the left Achilles tendon during initial encounter. |
|
| M66.372 | Spontaneous rupture of left Achilles tendon | Use for chronic or spontaneous rupture without acute trauma. |
|
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 tendon rupture
Essential facts and insights about Achilles Tendon Injury
Primary ICD-10-CM Codes for achilles tendon injury
Decision Criteria
clinical Criteria
- Presence of acute trauma and positive diagnostic tests
Applicable To
- Acute rupture of left Achilles tendon
Excludes
- Chronic Achilles tendinopathy (M76.62)
Clinical Validation Requirements
- Positive Thompson test
- MRI showing complete rupture
Code-Specific Risks
- Incorrectly coding as a sprain
- Missing laterality
Coding Notes
- Ensure documentation specifies acute trauma and laterality.
M66.372 - Spontaneous rupture of left Achilles tendon
Use for chronic or spontaneous rupture without acute trauma.
Applicable To
- Chronic rupture of left Achilles tendon
Excludes
- Acute traumatic rupture (S86.012A)
Clinical Validation Requirements
- MRI showing chronic degeneration
- Absence of acute trauma history
Coding Notes
Document absence of acute trauma and presence of chronic degeneration.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Achilles tendinitis
M76.62Differential 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 Tendon Injury to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S86.012A.
Impact
Clinical: Ambiguity in treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Use templates that prompt for laterality., Regular training on documentation standards.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Use S86.01- for tendon strain/rupture.
Impact
Using acute codes for chronic conditions can lead to audits.
Mitigation Strategy
Ensure clear documentation of trauma history and chronicity.
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 Tendon Injury, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Achilles Tendon Injury
Use these documentation templates to ensure complete and accurate documentation for Achilles Tendon Injury. These templates include all required elements for proper coding and billing.
Acute Achilles tendon rupture in ED
Specialty: Emergency MedicineRequired Elements
- Mechanism of injury
- Physical exam findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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