ICD-10 Coding for Tear of Achilles Tendon(S86.011A, M66.362)
Complete ICD-10-CM coding and documentation guide for Tear of Achilles Tendon. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tear of Achilles 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 |
|---|---|---|---|
| S86.011A | Strain of right Achilles tendon, initial encounter | Use for traumatic injuries to the right Achilles tendon during the initial encounter. |
|
| M66.362 | Spontaneous rupture of left Achilles tendon | Use for spontaneous ruptures of the left Achilles tendon without 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 tear
Essential facts and insights about Tear of Achilles Tendon
Primary ICD-10-CM Codes for tear achilles tendon
Decision Criteria
clinical Criteria
- Presence of trauma and positive Thompson test
documentation Criteria
- Detailed mechanism of injury and imaging results
Applicable To
- Traumatic rupture of right Achilles tendon
Excludes
- Spontaneous rupture of Achilles tendon (M66.36-)
Clinical Validation Requirements
- Positive Thompson test
- MRI showing complete tear
- History of trauma
Code-Specific Risks
- Incorrectly coding as tendinitis (M76.6-)
Coding Notes
- Ensure documentation specifies laterality and encounter type.
M66.362 - Spontaneous rupture of left Achilles tendon
Use for spontaneous ruptures of the left Achilles tendon without trauma.
Applicable To
- Non-traumatic rupture of left Achilles tendon
Excludes
- Traumatic rupture of Achilles tendon (S86.0-)
Clinical Validation Requirements
- MRI showing chronic tendinopathy
- No history of trauma
Coding Notes
Document absence of trauma and presence of underlying conditions.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall on same level from slipping, tripping and stumbling without subsequent striking against object, initial encounter
W00.0XXADifferential 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 Tear of Achilles Tendon to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S86.011A.
Impact
Clinical: Ambiguity in treatment records., Regulatory: Potential for claim denials., Financial: Delayed reimbursement.
Mitigation Strategy
Always document the affected side., Use electronic prompts to ensure laterality is captured.
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use S86.0- for traumatic injuries with clear trauma history.
Impact
Using tendinitis codes for ruptures.
Mitigation Strategy
Educate coders on differentiation criteria.
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 Tear of Achilles Tendon, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tear of Achilles Tendon
Use these documentation templates to ensure complete and accurate documentation for Tear of Achilles Tendon. These templates include all required elements for proper coding and billing.
Acute Traumatic Rupture
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Physical exam findings
- Imaging results
- Laterality
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Tear of Achilles Tendon? Ask your questions below.