Question 1

What is ICD-10 code M66.262?

Accepted Answer

M66.262 is the ICD-10-CM diagnosis code for spontaneous rupture of extensor tendons, left lower leg. A sudden, unexpected tearing of the extensor tendons (muscles that straighten the foot and toes) in the left lower leg, occurring without a specific injury. M66.262 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering disorders of synovium and tendon (m65-m67).

M66.262 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Verify laterality is documented as left; if not specified, use M66.269 instead.

Question 2

Is M66.262 an HCC code?

Accepted Answer

No. M66.262 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is M66.262 billable?

Accepted Answer

Yes. M66.262 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. M66.262 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for M66.262?

Accepted Answer

M66.262 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards M66.262 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting M66.262?

Accepted Answer

Verify laterality is documented as left; if not specified, use M66.269 instead This code indicates spontaneous rupture, so confirm there was no traumatic event documented

M66.262

Is M66.262 an HCC code?

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