Orthopedic Coding Alert

Question: What is the correct diagnosis code for an acute, traumatic rupture of the distal tendon of the biceps at the elbow (not the long tendon of the biceps)?

California Subscriber

Answer: For an acute rupture, choose 840.8 (Sprains and strains of shoulder and upper arm; other specified sites of shoulder and upper arm). The biceps is located above the elbow and ICD-9 coding guidelines state that the "upper arm" includes the elbow joint and humerus, which point to 840.8.

You'll choose differently for a chronic or old rupture. In that case, select 727.62 (Rupture of tendon, nontraumatic; tendons of biceps [long head]).