ICD-10 Coding for Patellar Tendon Rupture(M66.261, M66.262, S76.111)
Complete ICD-10-CM coding and documentation guide for Patellar Tendon Rupture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Patellar Tendon Rupture
M66.26-Primary Range
Spontaneous rupture of extensor tendons of the lower leg
This range covers non-traumatic ruptures of the patellar tendon, often due to degenerative changes.
Injury of patellar tendon
This range is used for traumatic ruptures of the patellar tendon, typically resulting from acute injury.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M66.261 | Spontaneous rupture of extensor tendons of the lower leg, right leg | Use when the rupture is non-traumatic and affects the right leg. |
|
| M66.262 | Spontaneous rupture of extensor tendons of the lower leg, left leg | Use when the rupture is non-traumatic and affects the left leg. |
|
| S76.111 | Strain of right patellar tendon | Use for traumatic ruptures with a clear acute 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 right patellar tendon rupture
Essential facts and insights about Patellar Tendon Rupture
Primary ICD-10-CM Codes for patellar tendon rupture
Decision Criteria
clinical Criteria
- Confirmed degenerative changes on imaging
Applicable To
- Non-traumatic rupture of right patellar tendon
Excludes
- Traumatic rupture of right patellar tendon (S76.111)
Clinical Validation Requirements
- MRI showing degenerative changes
- History of chronic tendinopathy
Code-Specific Risks
- Misclassification as traumatic rupture
Coding Notes
- Ensure documentation specifies non-traumatic origin and laterality.
M66.262 - Spontaneous rupture of extensor tendons of the lower leg, left leg
Use when the rupture is non-traumatic and affects the left leg.
Applicable To
- Non-traumatic rupture of left patellar tendon
Excludes
- Traumatic rupture of left patellar tendon (S76.112)
Clinical Validation Requirements
- MRI showing degenerative changes
- History of chronic tendinopathy
Coding Notes
Ensure documentation specifies non-traumatic origin and laterality.
S76.111 - Strain of right patellar tendon
Use for traumatic ruptures with a clear acute event.
Applicable To
- Traumatic rupture of right patellar tendon
Excludes
- Non-traumatic rupture of right patellar tendon (M66.261)
Clinical Validation Requirements
- Acute injury mechanism
- Physical exam findings consistent with trauma
Coding Notes
Document the traumatic event and use appropriate external cause codes.
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 Patellar Tendon Rupture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M66.261.
Impact
Clinical: Leads to ambiguity in treatment records., Regulatory: May result in compliance issues., Financial: Can cause claim denials or delays.
Mitigation Strategy
Always document the side affected in the medical record.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Misclassification can result in compliance issues., Data Quality: Impacts the accuracy of clinical data.
Mitigation Strategy
Ensure documentation clearly specifies the mechanism of injury.
Impact
Inadequate documentation of traumatic events can lead to audit findings.
Mitigation Strategy
Ensure all traumatic events are clearly documented with supporting evidence.
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 Patellar Tendon Rupture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Patellar Tendon Rupture
Use these documentation templates to ensure complete and accurate documentation for Patellar Tendon Rupture. These templates include all required elements for proper coding and billing.
Post-operative follow-up
Specialty: OrthopedicsRequired Elements
- Procedure performed
- Post-operative status
- Rehabilitation plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Patellar Tendon Rupture? Ask your questions below.