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ICD-10 Guide
ICD-10 CodesM61.15

M61.15

Billable

Myositis ossificans progressiva, thigh

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

Code Description

ICD-10 M61.15 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, thigh.

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, leading to dysregulation of bone morphogenetic proteins (BMPs) that promote ossification. In the thigh, patients may experience progressive muscle weakness, stiffness, and pain due to the formation of heterotopic ossification, which can severely limit mobility and function. The onset of symptoms typically occurs in early childhood, with episodes of soft tissue swelling and inflammation preceding the ossification. Diagnosis is primarily clinical, supported by imaging studies such as X-rays or MRI, which reveal calcifications in the affected muscles. Management focuses on symptomatic relief, physical therapy, and avoiding trauma, as injuries can exacerbate ossification. Surgical intervention is generally avoided due to the risk of further ossification. Understanding the complexities of MOP is crucial for accurate coding and effective patient management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rare condition with limited awareness among healthcare providers
  • Genetic testing may be required for definitive diagnosis
  • Differentiation from other myositis conditions is necessary
  • Potential for misdiagnosis due to overlapping symptoms with other disorders

Audit Risk Factors

  • Insufficient documentation of the genetic basis of the condition
  • Lack of imaging studies to support the diagnosis
  • Inadequate detail on the extent of muscle involvement
  • Misuse of related codes for more common myositis conditions

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical history, genetic testing results, imaging studies, and treatment plans.

Common Clinical Scenarios

Patients presenting with unexplained muscle pain and swelling, particularly in the thigh region.

Billing Considerations

Rheumatologists should be aware of the genetic implications and the need for multidisciplinary management.

Orthopedics

Documentation Requirements

Surgical history, imaging results, and functional assessments.

Common Clinical Scenarios

Patients with progressive stiffness and limited range of motion in the thigh due to ossification.

Billing Considerations

Orthopedic surgeons should avoid surgical interventions that may trigger further ossification.

Coding Guidelines

Inclusion Criteria

Use M61.15 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the condition's specifics, including the affected muscle group and any associated symptoms
  • Include any relevant imaging findings and genetic testing results

Exclusion Criteria

Do NOT use M61.15 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97001CPT Code

Physical therapy evaluation

Clinical Scenario

Used for assessing functional limitations in patients with MOP.

Documentation Requirements

Detailed evaluation of muscle strength, range of motion, and functional capabilities.

Specialty Considerations

Physical therapists should document the impact of MOP on daily activities.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of myositis ossificans progressiva, improving the accuracy of data collection and enhancing the understanding of this rare condition in clinical practice.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of myositis ossificans progressiva, improving the accuracy of data collection and enhancing the understanding of this rare condition in clinical practice.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of myositis ossificans progressiva, improving the accuracy of data collection and enhancing the understanding of this rare condition in clinical practice.

Resources

Clinical References

  • •
    Myositis Association

Coding & Billing References

  • •
    Myositis Association

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 weakness.

How is myositis ossificans progressiva diagnosed?

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

What are the treatment options for myositis ossificans progressiva?

Treatment focuses on symptom management, physical therapy, and avoiding trauma. Surgical options are generally avoided due to the risk of exacerbating the condition.