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ICD-10 Guide
ICD-10 CodesM61.019

M61.019

Billable

Myositis ossificans traumatica, unspecified shoulder

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M61.019 is a billable code used to indicate a diagnosis of myositis ossificans traumatica, unspecified shoulder.

Key Diagnostic Point:

Myositis ossificans traumatica is a condition characterized by the abnormal formation of bone tissue within muscle or soft tissue following trauma. This condition typically occurs after a significant injury, such as a fracture or severe contusion, leading to inflammation and subsequent ossification in the affected area. In the case of the unspecified shoulder, the condition may manifest as pain, swelling, and restricted range of motion in the shoulder joint. Patients may experience muscle weakness due to the infiltration of bone into muscle tissue, which can further complicate rehabilitation efforts. Diagnosis is often confirmed through imaging studies, such as X-rays or MRI, which reveal calcification or ossification in the muscle. Treatment may involve physical therapy, pain management, and in some cases, surgical intervention to remove the ossified tissue. Understanding the nuances of myositis ossificans is crucial for accurate coding and effective patient management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of symptoms
  • Need for precise documentation of trauma history
  • Differentiation from other musculoskeletal conditions
  • Potential for co-existing conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of the traumatic event
  • Failure to specify the location of ossification
  • Misinterpretation of imaging results
  • Coding without confirming the diagnosis through clinical evaluation

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of trauma, imaging results, and treatment plans.

Common Clinical Scenarios

Post-traumatic shoulder pain with limited mobility and imaging showing ossification.

Billing Considerations

Ensure clear documentation of the mechanism of injury and any surgical interventions.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, treatment goals, and progress notes.

Common Clinical Scenarios

Rehabilitation following trauma with myositis ossificans affecting shoulder function.

Billing Considerations

Documenting the impact of muscle weakness on rehabilitation outcomes is crucial.

Coding Guidelines

Inclusion Criteria

Use M61.019 When
  • Follow the official ICD
  • CM coding guidelines for myositis ossificans, ensuring accurate documentation of the trauma and clinical findings
  • Include any relevant imaging studies to support the diagnosis

Exclusion Criteria

Do NOT use M61.019 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used for pain management in cases of myositis ossificans.

Documentation Requirements

Document the indication for the procedure and any imaging findings.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between the diagnosis and the procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like myositis ossificans, improving the accuracy of patient records and facilitating better treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like myositis ossificans, improving the accuracy of patient records and facilitating better treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like myositis ossificans, improving the accuracy of patient records and facilitating better treatment planning.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is myositis ossificans traumatica?

Myositis ossificans traumatica is a condition where bone tissue forms in muscle or soft tissue following trauma, leading to pain and restricted movement.

How is myositis ossificans diagnosed?

Diagnosis is typically made through a combination of patient history, physical examination, and imaging studies such as X-rays or MRI.

What are the treatment options for myositis ossificans?

Treatment may include physical therapy, pain management, and in some cases, surgical intervention to remove the ossified tissue.