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ICD-10 Guide
ICD-10 CodesM61.12

M61.12

Billable

Myositis ossificans progressiva, upper arm

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

Code Description

ICD-10 M61.12 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, upper arm.

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 begins in early childhood and progresses over time, leading to significant muscle weakness and restricted mobility. In the case of M61.12, the focus is specifically on the upper arm, where ossification can lead to stiffness and pain, severely impacting the patient's ability to perform daily activities. The condition is caused by mutations in the ACVR1 gene, which plays a crucial role in bone growth and development. Patients may experience episodes of swelling and inflammation in the affected muscles, followed by the gradual development of bone tissue. Diagnosis is often confirmed through imaging studies such as X-rays or MRI, which reveal the presence of heterotopic ossification. Management of MOP is primarily supportive, focusing on physical therapy to maintain mobility and prevent contractures, as surgical intervention is often complicated by the risk of further ossification.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rarity of the condition makes it less familiar to coders.
  • Specificity required in documentation to differentiate from other myositis conditions.
  • Potential for misdiagnosis with other musculoskeletal disorders.
  • Need for detailed clinical history to support the diagnosis.

Audit Risk Factors

  • Insufficient documentation of clinical findings.
  • Lack of genetic testing results in the medical record.
  • Inadequate detail on the progression of symptoms.
  • Failure to document the impact on daily living activities.

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical notes on symptoms, physical examination findings, and treatment plans.

Common Clinical Scenarios

Patients presenting with muscle pain and swelling, particularly in the upper arm, with a family history of similar conditions.

Billing Considerations

Documentation should include genetic testing results and imaging studies to support the diagnosis.

Orthopedics

Documentation Requirements

Surgical notes if intervention is performed, along with pre-operative and post-operative assessments.

Common Clinical Scenarios

Patients requiring surgical intervention for severe contractures or functional impairment.

Billing Considerations

Careful documentation of the risks associated with surgery due to the nature of the condition.

Coding Guidelines

Inclusion Criteria

Use M61.12 When
  • According to ICD
  • 10 coding guidelines, M61
  • 12 should be used when the condition is specifically diagnosed and documented by a qualified healthcare provider
  • It is important to ensure that the diagnosis is supported by clinical findings and imaging results

Exclusion Criteria

Do NOT use M61.12 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97110CPT Code

Therapeutic exercises

Clinical Scenario

Used for rehabilitation of muscle strength in patients with MOP.

Documentation Requirements

Documentation of the patient's progress and specific exercises performed.

Specialty Considerations

Physical therapy notes should detail the patient's response to therapy.

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 data accuracy and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving data accuracy and facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving data accuracy and facilitating better patient management.

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 disability.

How is M61.12 diagnosed?

Diagnosis is based on clinical evaluation, imaging studies showing heterotopic ossification, and genetic testing for ACVR1 mutations.