ICD Code M66.311

ICD code M66.311 is used to classify and document a medical diagnosis of a spontaneous rupture of the flexor tendons in the right shoulder. This condition refers to an unexpected tearing or breaking of the tendons that help in bending or flexing the shoulder joint. Such ruptures can occur without any apparent injury or trauma, often due to underlying conditions like tendon degeneration or overuse. Proper coding of this condition is crucial for accurate medical records, billing, and insurance claims processing within the healthcare revenue cycle.

When to use the ICD code for spontaneous rupture of flexor tendons in the right shoulder, consider the following diagnostic criteria and symptoms:

1. Patient History
- Previous shoulder injuries or surgeries
- History of repetitive shoulder use or strain

2. Clinical Presentation
- Sudden onset of pain in the right shoulder
- Limited range of motion in the shoulder joint
- Swelling or tenderness in the shoulder area

3. Physical Examination Findings
- Palpable defect or abnormality in the tendon area
- Positive signs of tendon rupture during physical examination (e.g., inability to flex the fingers)

4. Imaging Studies
- MRI or ultrasound confirming the rupture of flexor tendons
- X-rays to rule out associated fractures or other injuries

5. Functional Impairment
- Difficulty performing daily activities that require shoulder movement
- Weakness in the affected arm or hand

6. Exclusion of Other Conditions
- Ruling out other causes of shoulder pain (e.g., rotator cuff injuries, tendonitis)
- Ensuring no underlying systemic conditions contributing to tendon weakness

These criteria should guide healthcare providers in determining the appropriate use of the ICD code for this specific diagnosis.

For the ICD code M66.311, which pertains to the spontaneous rupture of flexor tendons in the right shoulder, the relevant CPT codes that may be applicable for treatment include:

1. 23410 - Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; acute.

2. 23412 - Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic.

3. 23420 - Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty).

4. 24341 - Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff).

5. 24342 - Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft.

These CPT codes are typically used to describe surgical procedures that may be necessary to address tendon ruptures in the shoulder area. It is important for healthcare providers to select the appropriate CPT code based on the specific procedure performed and the clinical scenario. Always ensure that the chosen CPT code aligns with the documentation and the services provided.

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