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v1.0.0
ICD-10 Guide
ICD-10 CodesM61.1

M61.1

Billable

Myositis ossificans progressiva

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

Code Description

ICD-10 M61.1 is a billable code used to indicate a diagnosis of myositis ossificans progressiva.

Key Diagnostic Point:

Myositis ossificans progressiva (MOP) is a rare genetic disorder characterized by the abnormal formation of bone in muscles, tendons, and other connective tissues. This condition is caused by mutations in the ACVR1 gene, which plays a crucial role in the regulation of bone growth and development. Patients with MOP typically experience progressive muscle stiffness and weakness, often beginning in childhood or early adulthood. The hallmark of this disorder is the formation of heterotopic ossification, where bone tissue forms in areas where it should not, leading to significant mobility limitations and pain. The condition is often misdiagnosed as other muscle disorders due to its symptoms, which can include muscle swelling, tenderness, and decreased range of motion. Diagnosis is primarily clinical, supported by imaging studies that reveal abnormal bone formation. Management is symptomatic, focusing on pain relief and maintaining mobility, as surgical intervention can exacerbate the condition. Understanding the genetic basis and clinical presentation of MOP is essential for accurate diagnosis and management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rare condition with limited awareness among healthcare providers
  • Requires genetic testing for definitive diagnosis
  • Symptoms overlap with other musculoskeletal disorders
  • Need for precise documentation of clinical findings

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to document the progression of symptoms
  • Misclassification of the condition as a more common myopathy
  • Lack of detailed clinical notes regarding treatment plans

Specialty Focus

Medical Specialties

Genetics

Documentation Requirements

Detailed family history and genetic testing results must be documented.

Common Clinical Scenarios

Patients presenting with unexplained muscle stiffness and pain, particularly in childhood.

Billing Considerations

Genetic counseling may be necessary for affected families.

Orthopedics

Documentation Requirements

Comprehensive assessment of mobility limitations and imaging studies showing ossification.

Common Clinical Scenarios

Patients requiring surgical evaluation for mobility issues due to heterotopic ossification.

Billing Considerations

Surgical interventions should be approached with caution due to the risk of exacerbating the condition.

Coding Guidelines

Inclusion Criteria

Use M61.1 When
  • According to ICD
  • 10 coding guidelines, M61
  • 1 should be used when the condition is confirmed through clinical evaluation and genetic testing
  • It is essential to document the specific symptoms and progression of the disease to support the diagnosis

Exclusion Criteria

Do NOT use M61.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81403CPT Code

Genetic testing for ACVR1 mutations

Clinical Scenario

Used when a patient is suspected of having MOP based on clinical symptoms.

Documentation Requirements

Documentation of clinical symptoms and family history is required to justify genetic testing.

Specialty Considerations

Genetic specialists should ensure comprehensive family history is included.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of rare conditions like MOP, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of rare conditions like MOP, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    Myositis Ossificans Progressiva Foundation

Coding & Billing References

  • •
    Myositis Ossificans Progressiva Foundation

Frequently Asked Questions

What are the common symptoms of Myositis ossificans progressiva?

Common symptoms include progressive muscle stiffness, weakness, swelling, and pain in affected areas, often leading to significant mobility limitations.