ICD-10 Coding for Peroneal Tendon Tear(S86.511A, M66.88)
Complete ICD-10-CM coding and documentation guide for Peroneal Tendon Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Peroneal Tendon Tear
S86.3-S86.5Primary Range
Injury of muscle and tendon at lower leg level
Includes traumatic and strain injuries of the peroneal tendons.
Spontaneous rupture of other tendons
Used for nontraumatic, degenerative tears of the peroneal tendons.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S86.511A | Strain of peroneal muscle and tendon, right leg, initial encounter | Use for acute traumatic rupture of the peroneal tendon in the right leg. |
|
| M66.88 | Spontaneous rupture of other tendons, not elsewhere classified | Use for nontraumatic, degenerative tears of the peroneal tendons. |
|
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 peroneal tendon tear
Essential facts and insights about Peroneal Tendon Tear
Primary ICD-10-CM Codes for peroneal tendon tear
Decision Criteria
clinical Criteria
- Confirmed traumatic rupture via imaging
documentation Criteria
- Documented mechanism of injury
Applicable To
- Acute traumatic rupture of peroneal tendon
Excludes
- Nontraumatic rupture (M66.88)
Clinical Validation Requirements
- MRI showing complete tear
- Mechanism of injury documented
Code-Specific Risks
- Incorrect laterality
- Missing trauma documentation
Coding Notes
- Ensure documentation specifies the traumatic nature and laterality.
M66.88 - Spontaneous rupture of other tendons, not elsewhere classified
Use for nontraumatic, degenerative tears of the peroneal tendons.
Applicable To
- Degenerative tear of peroneal tendon
Excludes
- Traumatic rupture (S86.5-)
Clinical Validation Requirements
- MRI showing degenerative changes
- No history of trauma
Coding Notes
Ensure documentation specifies the degenerative nature and absence of trauma.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in right ankle and joints of right foot
M25.571Differential 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 Peroneal Tendon Tear to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S86.511A.
Impact
Clinical: Ambiguity in treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document laterality in clinical notes., Cross-check with imaging reports.
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Use S86.5- codes for traumatic tears.
Impact
Using nontraumatic codes for traumatic injuries.
Mitigation Strategy
Educate staff on differentiation criteria and ensure thorough documentation.
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 Peroneal Tendon Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Peroneal Tendon Tear
Use these documentation templates to ensure complete and accurate documentation for Peroneal Tendon Tear. These templates include all required elements for proper coding and billing.
Acute Traumatic Rupture
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Imaging findings
- Physical exam results
- Treatment plan
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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