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ICD-10 Guide
ICD-10 CodesM61.119

M61.119

Billable

Myositis ossificans progressiva, unspecified shoulder

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

Code Description

ICD-10 M61.119 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, unspecified shoulder.

Key Diagnostic Point:

Myositis ossificans progressiva (MOP) is a rare genetic disorder characterized by the abnormal formation of bone in muscles and connective tissues. This condition typically begins in early childhood and progresses over time, leading to significant muscle weakness and restricted mobility. In the case of unspecified shoulder involvement, patients may experience stiffness, pain, and decreased range of motion in the shoulder joint due to the ossification process. The condition is caused by mutations in the ACVR1 gene, which plays a crucial role in bone development and regulation. Diagnosis is often made through clinical evaluation, imaging studies, and family history. Management focuses on symptomatic relief, physical therapy, and avoiding trauma to affected areas to prevent exacerbation of ossification. Understanding the nuances of myositis ossificans progressiva is essential for accurate coding and appropriate patient care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Rare condition requiring specialized knowledge for accurate coding.
  • Potential for misdiagnosis with other muscle disorders.
  • Need for precise documentation of symptoms and progression.
  • Variability in clinical presentation among patients.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to specify the affected body part.
  • Misinterpretation of symptoms leading to incorrect coding.
  • Lack of genetic testing documentation.

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed history of symptoms, family history, and results of imaging studies.

Common Clinical Scenarios

Patients presenting with progressive muscle stiffness and pain, particularly in the shoulder region.

Billing Considerations

Documentation should clearly outline the progression of symptoms and any interventions attempted.

Genetics

Documentation Requirements

Genetic testing results, family pedigree, and detailed clinical evaluation.

Common Clinical Scenarios

Patients with a family history of myositis ossificans or unexplained muscle ossification.

Billing Considerations

Accurate coding requires confirmation of genetic mutations associated with the condition.

Coding Guidelines

Inclusion Criteria

Use M61.119 When
  • According to ICD
  • 10 guidelines, M61
  • 119 should be used when myositis ossificans progressiva is confirmed but the specific shoulder involvement is not documented
  • Coders should ensure that the diagnosis is supported by clinical findings and imaging results

Exclusion Criteria

Do NOT use M61.119 When
  • Exclusion criteria include other forms of myositis or muscle disorders that do not involve ossification

Related ICD-10 Codes

Related CPT Codes

97001CPT Code

Physical therapy evaluation

Clinical Scenario

Used for assessing functional limitations in patients with myositis ossificans progressiva.

Documentation Requirements

Detailed evaluation of range of motion and functional capacity.

Specialty Considerations

Rheumatology and physical therapy should coordinate documentation.

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 myositis ossificans progressiva, improving the accuracy of patient records and facilitating better research and treatment options.

ICD-9 vs ICD-10

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

Reimbursement & Billing Impact

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

Resources

Clinical References

  • •
    Myositis ossificans progressiva overview

Coding & Billing References

  • •
    Myositis ossificans progressiva overview

Frequently Asked Questions

What is myositis ossificans progressiva?

Myositis ossificans progressiva is a rare genetic disorder characterized by the abnormal formation of bone in muscles and connective tissues, leading to progressive stiffness and pain.

How is myositis ossificans progressiva diagnosed?

Diagnosis is typically made through clinical evaluation, imaging studies, and genetic testing to confirm mutations in the ACVR1 gene.