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ICD-10 Guide
ICD-10 CodesM61.112

M61.112

Billable

Myositis ossificans progressiva, left shoulder

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

Code Description

ICD-10 M61.112 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, left shoulder.

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 typically manifests after trauma or injury, leading to progressive ossification, particularly in the muscles of the shoulder, neck, and back. In the case of M61.112, the focus is on the left shoulder, where patients may experience significant muscle weakness, stiffness, and pain due to the formation of heterotopic bone. The condition is often misdiagnosed as other muscle disorders or injuries, which can delay appropriate treatment. Diagnosis is primarily clinical, supported by imaging studies such as X-rays or MRIs that reveal calcification in soft tissues. Management strategies may include physical therapy, pain management, and in some cases, surgical intervention to remove the ossified tissue. Understanding the nuances of this condition is crucial for accurate coding and effective patient management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rarity of the condition leading to potential misdiagnosis.
  • Need for precise documentation of symptoms and imaging findings.
  • Differentiation from other muscle disorders and conditions.
  • Potential for co-existing conditions that complicate coding.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to specify laterality (left vs. right).
  • Misinterpretation of imaging results.
  • Inconsistent coding of associated conditions.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with shoulder pain and limited range of motion post-injury.

Billing Considerations

Ensure accurate laterality is documented and that all imaging studies are included in the medical record.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Patients requiring rehabilitation post-surgery for ossification removal.

Billing Considerations

Document progress and response to therapy to support ongoing treatment needs.

Coding Guidelines

Inclusion Criteria

Use M61.112 When
  • According to ICD
  • 10 coding guidelines, M61
  • 112 should be used when there is clear documentation of myositis ossificans progressiva affecting the left shoulder
  • Coders should ensure that all relevant clinical information is captured, including the patient's history, physical examination findings, and any imaging studies that support the diagnosis

Exclusion Criteria

Do NOT use M61.112 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 patients with myositis ossificans progressiva.

Documentation Requirements

Document the indication for the procedure and any imaging findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is linked to the diagnosis.

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 progressiva, improving the accuracy of patient records and facilitating better management of care. The specificity of M61.112 helps in tracking the prevalence and treatment outcomes of this rare condition.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like myositis ossificans progressiva, improving the accuracy of patient records and facilitating better management of care. The specificity of M61.112 helps in tracking the prevalence and treatment outcomes of this rare condition.

Reimbursement & Billing Impact

reimbursement and to avoid denials.

Resources

Clinical References

  • •
    Myositis Ossificans Progressiva Foundation

Coding & Billing References

  • •
    Myositis Ossificans Progressiva Foundation

Frequently Asked Questions

What is myositis ossificans progressiva?

Myositis ossificans progressiva is a rare genetic disorder characterized by the abnormal formation of bone in soft tissues, often following trauma, leading to muscle stiffness and weakness.

How is M61.112 diagnosed?

Diagnosis of M61.112 involves clinical evaluation, imaging studies such as X-rays or MRIs, and a thorough patient history to differentiate it from other muscle disorders.