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ICD-10 Coding for Rupture of Achilles Tendon(S86.012A, M66.361)

Complete ICD-10-CM coding and documentation guide for Rupture of Achilles Tendon. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Achilles Tendon TearAchilles Tendon Rupture

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Related ICD-10 Code Ranges

Complete code families applicable to Rupture of Achilles Tendon

S86.0-S86.01Primary Range

Injury of Achilles tendon

This range covers traumatic ruptures of the Achilles tendon.

M66.36

Spontaneous rupture of Achilles tendon

This code is used for spontaneous ruptures without trauma.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
S86.012AStrain of left Achilles tendon, initial encounterUse for traumatic ruptures with a clear mechanism of injury.
  • Mechanism of injury documented
  • Positive Thompson test
  • Imaging confirmation (MRI/US)
M66.361Spontaneous rupture of right Achilles tendonUse for spontaneous ruptures without a traumatic event.
  • No history of trauma
  • Possible history of tendinopathy or steroid use

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 ruptured Achilles tendon

Essential facts and insights about Rupture of Achilles Tendon

The ICD-10 code for a traumatic rupture of the Achilles tendon is S86.012A for the left leg. For spontaneous ruptures, use M66.361 for the right leg.

Primary ICD-10-CM Codes for rupture of achilles tendon

S86.012A
Strain of left Achilles tendon, initial encounter
Billable Code

Decision Criteria

clinical Criteria

  • Documented traumatic event leading to rupture

coding Criteria

  • Use external cause codes for traumatic events

Applicable To

  • Traumatic rupture of left Achilles tendon

Excludes

  • Spontaneous rupture of Achilles tendon (M66.36)

Clinical Validation Requirements

  • Mechanism of injury documented
  • Positive Thompson test
  • Imaging confirmation (MRI/US)

Code-Specific Risks

  • Incorrectly coding as spontaneous
  • Omitting laterality

Coding Notes

  • Ensure laterality is specified and link to external cause codes for traumatic cases.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Long-term (current) use of steroids

Z79.2
Use if steroid use is a contributing factor.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Spontaneous rupture of right Achilles tendon

M66.361
No trauma history, often associated with tendinopathy.

Strain of left Achilles tendon, initial encounter

S86.012A
Involves a traumatic event.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Rupture of Achilles Tendon to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S86.012A.

Impact

Clinical: Leads to vague clinical records., Regulatory: Non-compliance with ICD-10 specificity requirements., Financial: Potential for claim denials.

Mitigation Strategy

Always specify laterality and mechanism., Use specific codes whenever possible.

Impact

Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.

Mitigation Strategy

Verify the mechanism of injury and document appropriately.

Impact

Reimbursement: Claims may be rejected for lack of specificity., Compliance: Fails to meet ICD-10 coding requirements., Data Quality: Inaccurate patient records.

Mitigation Strategy

Always specify 'left' or 'right' in the documentation.

Impact

Lack of specificity can lead to audit flags.

Mitigation Strategy

Ensure all documentation includes laterality and mechanism.

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 Rupture of Achilles Tendon, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Rupture of Achilles Tendon

Use these documentation templates to ensure complete and accurate documentation for Rupture of Achilles Tendon. These templates include all required elements for proper coding and billing.

Traumatic rupture during sports

Specialty: Orthopedics

Required Elements

  • Mechanism of injury
  • Physical exam findings
  • Imaging results
  • Treatment plan

Example Documentation

Patient reports a pop during basketball. Exam shows a palpable gap and positive Thompson test. MRI confirms rupture. Plan for surgical repair.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Achilles torn. Will repair.
Good Documentation Example
Complete traumatic rupture of left Achilles tendon (3cm gap) during soccer game. MRI confirms. Scheduled for primary repair without graft.
Explanation
The good example provides specific details on the injury, confirmation, and treatment plan.

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