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ICD-10 Guide
ICD-10 CodesM61.16

M61.16

Billable

Myositis ossificans progressiva, lower leg

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

Code Description

ICD-10 M61.16 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, lower leg.

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 in childhood or early adulthood and is caused by mutations in the ACVR1 gene, which plays a crucial role in bone growth and development. In the lower leg, patients may experience progressive muscle weakness, stiffness, and pain due to the ossification of muscle tissue. The condition often leads to significant functional impairment, as the formation of bone in soft tissues restricts movement and can result in joint deformities. Diagnosis is primarily clinical, supported by imaging studies such as X-rays or MRI, which reveal the characteristic heterotopic ossification. Management is symptomatic and may include physical therapy, pain management, and surgical intervention in severe cases. However, surgery is approached with caution due to the risk of exacerbating the condition. Understanding the complexities of MOP is essential for accurate coding and effective patient management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rarity of the condition leading to limited familiarity among coders
  • Need for precise documentation of clinical findings and imaging results
  • Potential for misdiagnosis with other myositis conditions
  • Complexity in distinguishing between acute and chronic presentations

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to include imaging studies in the medical record
  • Misclassification of the condition as a more common myopathy
  • Lack of clear treatment plans or follow-up documentation

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical notes including history, physical examination findings, and treatment plans.

Common Clinical Scenarios

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

Billing Considerations

Documentation should clearly differentiate MOP from other inflammatory myopathies.

Orthopedics

Documentation Requirements

Imaging results, surgical notes, and post-operative care documentation.

Common Clinical Scenarios

Patients requiring surgical intervention for severe ossification.

Billing Considerations

Careful documentation of surgical risks due to the nature of the condition.

Coding Guidelines

Inclusion Criteria

Use M61.16 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the condition's clinical features and any associated complications
  • Include relevant imaging studies and treatment plans in the medical record

Exclusion Criteria

Do NOT use M61.16 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 when joint aspiration is needed due to complications from MOP.

Documentation Requirements

Document the indication for the procedure and any imaging findings.

Specialty Considerations

Orthopedic specialists should ensure clear documentation of the relationship between the procedure and MOP.

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 aids in better understanding the condition's prevalence and management outcomes.

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 aids in better understanding the condition's prevalence and management outcomes.

Reimbursement & Billing Impact

reimbursement processes. This specificity aids in better understanding the condition's prevalence and management outcomes.

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 disability.

How is M61.16 diagnosed?

Diagnosis is based on clinical presentation, family history, and imaging studies that reveal heterotopic ossification.

What are the treatment options for M61.16?

Treatment focuses on symptom management, physical therapy, and, in severe cases, surgical intervention, although surgery carries risks.