ICD-10 Coding for Biceps Tendon Rupture(S46.11XA, M66.821)
Complete ICD-10-CM coding and documentation guide for Biceps Tendon Rupture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Biceps Tendon Rupture
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S46.11XA | Traumatic rupture of right long head of biceps, initial encounter | For acute traumatic ruptures of the right biceps tendon. |
|
| M66.821 | Spontaneous rupture of right upper arm tendon | For nontraumatic, spontaneous 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 biceps tendon rupture
Essential facts and insights about Biceps Tendon Rupture
Primary ICD-10-CM Codes for biceps tendon rupture
Decision Criteria
clinical Criteria
- Presence of traumatic event leading to rupture
Applicable To
- Acute traumatic rupture of right biceps tendon
Excludes
- Spontaneous rupture of biceps tendon
Clinical Validation Requirements
- MRI showing complete rupture
- Physical exam with Popeye sign
Code-Specific Risks
- Incorrectly coding as spontaneous rupture
Coding Notes
- Ensure documentation specifies traumatic cause.
M66.821 - Spontaneous rupture of right upper arm tendon
For nontraumatic, spontaneous ruptures of the right biceps tendon.
Applicable To
- Nontraumatic rupture of right biceps tendon
Excludes
- Traumatic rupture of biceps tendon
Clinical Validation Requirements
- MRI showing degenerative changes
- History of corticosteroid use
Coding Notes
Ensure documentation specifies nontraumatic cause.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Rupture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S46.11XA.
Impact
Clinical: Leads to incorrect diagnosis and treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Use specific clinical terms and imaging results.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation clearly specifies the cause of rupture.
Impact
Using the wrong code for the type of rupture.
Mitigation Strategy
Ensure documentation clearly differentiates between traumatic and nontraumatic causes.
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 Rupture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Biceps Tendon Rupture
Use these documentation templates to ensure complete and accurate documentation for Biceps Tendon Rupture. These templates include all required elements for proper coding and billing.
Acute traumatic rupture during physical activity
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Clinical signs (e.g., Popeye sign)
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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