ICD-10 Coding for Torn Achilles Tendon(S86.01xA, M66.36x)
Complete ICD-10-CM coding and documentation guide for Torn Achilles Tendon. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Torn Achilles Tendon
S86.01-S86.09Primary Range
Injury of Achilles tendon
This range includes codes for traumatic injuries to the Achilles tendon, such as ruptures and strains.
Spontaneous rupture of Achilles tendon
This code is used for non-traumatic, spontaneous ruptures of the 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 |
|---|---|---|---|
| S86.01xA | Strain of Achilles tendon, initial encounter | Use for acute traumatic ruptures of the Achilles tendon. |
|
| M66.36x | Spontaneous rupture of Achilles tendon | Use for non-traumatic, spontaneous ruptures. |
|
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 torn Achilles tendon
Essential facts and insights about Torn Achilles Tendon
Primary ICD-10-CM Codes for torn achilles tendon
Decision Criteria
clinical Criteria
- Presence of a traumatic event leading to rupture.
documentation Criteria
- Detailed description of the injury mechanism and physical exam findings.
Applicable To
- Traumatic rupture of Achilles tendon
Excludes
- Achilles tendinitis (M76.6)
Clinical Validation Requirements
- Positive Thompson test
- MRI showing complete rupture
Code-Specific Risks
- Confusion with tendinitis codes
- Missing laterality
Coding Notes
- Ensure documentation specifies the mechanism of injury and laterality.
M66.36x - Spontaneous rupture of Achilles tendon
Use for non-traumatic, spontaneous ruptures.
Applicable To
- Degenerative rupture of Achilles tendon
Excludes
- Traumatic rupture of Achilles tendon (S86.01x)
Clinical Validation Requirements
- Ultrasound showing degenerative changes
- Absence of trauma history
Coding Notes
Document absence of trauma and presence of degenerative changes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall from curb, initial encounter
W18.41xADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Torn Achilles Tendon to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S86.01xA.
Impact
Clinical: Impacts treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document RT or LT in clinical notes.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Misclassification affects compliance with coding standards., Data Quality: Impacts the accuracy of clinical data.
Mitigation Strategy
Ensure documentation specifies rupture, not just pain or inflammation.
Impact
Using M76.6 for ruptures can trigger audits.
Mitigation Strategy
Ensure clear documentation of rupture vs. tendinitis.
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 Torn Achilles Tendon, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Torn Achilles Tendon
Use these documentation templates to ensure complete and accurate documentation for Torn Achilles Tendon. These templates include all required elements for proper coding and billing.
Acute traumatic rupture during sports
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Physical exam findings
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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