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v1.0.0
ICD-10 Guide
ICD-10 CodesM61.151

M61.151

Billable

Myositis ossificans progressiva, right thigh

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

Code Description

ICD-10 M61.151 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, right 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 typically presents with progressive muscle stiffness and weakness, often beginning in childhood or early adulthood. In the case of M61.151, the ossification occurs specifically in the right thigh, leading to significant functional impairment. Patients may experience episodes of swelling and pain in the affected area, which can be mistaken for muscle strain or injury. The condition is caused by mutations in the ACVR1 gene, which plays a crucial role in bone growth and development. Diagnosis is primarily clinical, supported by imaging studies such as X-rays or MRI that reveal the presence of heterotopic ossification. Management focuses on symptomatic relief and physical therapy, as surgical intervention is often complicated by the risk of further ossification. Understanding the nuances of this condition is essential for accurate coding and appropriate patient management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Rarity of the condition leading to limited familiarity among coders
  • Need for precise documentation of the affected site (right thigh)
  • Potential for misdiagnosis with other muscle disorders
  • Requirement for genetic testing results to confirm diagnosis

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to include imaging results in the medical record
  • Misinterpretation of symptoms leading to incorrect coding
  • Lack of genetic testing documentation

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical notes including symptom onset, progression, and response to treatment.

Common Clinical Scenarios

Patients presenting with muscle stiffness and pain, particularly after minor trauma.

Billing Considerations

Documentation should clearly differentiate MOP from other inflammatory myopathies.

Orthopedics

Documentation Requirements

Imaging studies and surgical notes if intervention is considered.

Common Clinical Scenarios

Patients with progressive loss of mobility due to ossification.

Billing Considerations

Consideration of the risks associated with surgical procedures in patients with MOP.

Coding Guidelines

Inclusion Criteria

Use M61.151 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the condition's specifics, including laterality
  • Include any relevant imaging or genetic testing results to support the diagnosis

Exclusion Criteria

Do NOT use M61.151 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

Radiologic examination, hip, pelvis, or thigh

Clinical Scenario

Used to evaluate the extent of ossification in the right thigh.

Documentation Requirements

Include imaging results and clinical findings.

Specialty Considerations

Orthopedic specialists should document the rationale for imaging.

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 reimbursement processes. This specificity helps in better understanding the epidemiology and management of the condition.

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 reimbursement processes. This specificity helps in better understanding the epidemiology and management of the condition.

Reimbursement & Billing Impact

reimbursement processes. This specificity helps in better understanding the epidemiology and management of the condition.

Resources

Clinical References

  • •
    Myositis ossificans progressiva: A comprehensive overview

Coding & Billing References

  • •
    Myositis ossificans progressiva: A comprehensive 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 weakness.

How is M61.151 diagnosed?

Diagnosis is primarily clinical, supported by imaging studies and genetic testing to confirm the presence of mutations in the ACVR1 gene.

What are the treatment options for M61.151?

Management focuses on symptomatic relief, physical therapy, and careful monitoring, as surgical options may lead to complications.