ICD-10 Coding for Biceps Tendon Tear(S46.211A, M66.821)
Complete ICD-10-CM coding and documentation guide for Biceps Tendon Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Biceps Tendon Tear
S46.2Primary Range
Injury of muscle, fascia and tendon at shoulder and upper arm level
This range includes codes for traumatic injuries to the biceps tendon, such as strains and tears.
Spontaneous rupture of other tendons
This range includes codes for non-traumatic, degenerative ruptures of the biceps tendon.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S46.211A | Strain of muscle, fascia and tendon of other parts of biceps, right arm, initial encounter | Use for acute traumatic strains of the right biceps during the initial encounter. |
|
| M66.821 | Spontaneous rupture of other tendons, right arm | Use for non-traumatic, degenerative ruptures of the right biceps tendon. |
|
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 bicep tear
Essential facts and insights about Biceps Tendon Tear
Primary ICD-10-CM Codes for bicep tear
Decision Criteria
clinical Criteria
- Presence of traumatic mechanism
documentation Criteria
- Initial encounter status
Applicable To
- Acute traumatic strain of right biceps
Excludes
- Degenerative tears (M66.8-)
Clinical Validation Requirements
- Documented traumatic mechanism
- Right arm involvement
- Initial encounter
Code-Specific Risks
- Confusion with degenerative tears
Coding Notes
- Ensure documentation specifies the traumatic nature and laterality.
M66.821 - Spontaneous rupture of other tendons, right arm
Use for non-traumatic, degenerative ruptures of the right biceps tendon.
Applicable To
- Degenerative rupture of right biceps tendon
Excludes
- Traumatic tears (S46.2-)
Clinical Validation Requirements
- No traumatic mechanism
- Right arm involvement
- Degenerative changes on imaging
Coding Notes
Ensure documentation specifies the degenerative nature and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Rotator cuff tear
M75.2Differential 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 Biceps Tendon Tear to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S46.211A.
Impact
Clinical: Ambiguity in treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Use templates that prompt for laterality., Educate staff on the importance of complete documentation.
Impact
Reimbursement: Incorrect laterality can lead to denied claims., Compliance: Non-compliance with ICD-10 coding rules., Data Quality: Inaccurate patient records.
Mitigation Strategy
Always specify right or left arm in documentation.
Impact
Reimbursement: Incorrect coding may affect reimbursement rates., Compliance: Violates coding guidelines., Data Quality: Misleading clinical data.
Mitigation Strategy
Differentiate between traumatic and degenerative tears based on clinical history.
Impact
Failure to specify laterality can lead to audit flags.
Mitigation Strategy
Implement mandatory fields for laterality in EHR systems.
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 Biceps Tendon Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Biceps Tendon Tear
Use these documentation templates to ensure complete and accurate documentation for Biceps Tendon Tear. These templates include all required elements for proper coding and billing.
Acute traumatic biceps tear
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Laterality
- Imaging findings
- Functional impact
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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