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This is an overlapping occurrence between procedure and diagnosis coding.

Grade III is a complete rupture of a single pulley, and grade IV is multiple pulleys torn, often with visible bowstringing of the tendon

Ahmed SF, Achermann J, Alderson J, Crouch NS, Elford S, Hughes IA, Krone N, McGowan R, Mushtaq T, OToole S, Perry L, Rodie ME, Skae M, Turner HE (2021) Society for Endocrinology UK Guidance on the initial evaluation of a suspected difference or disorder of sex development (Revised 2021)