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ICD-10 Guide
ICD-10 CodesM61.161

M61.161

Billable

Myositis ossificans progressiva, right lower leg

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

Code Description

ICD-10 M61.161 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, right 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 often triggered by trauma or injury, although it can occur spontaneously. In the case of M61.161, the ossification occurs specifically in the right lower leg, leading to progressive muscle stiffness, weakness, and reduced mobility. Patients may experience episodes of swelling and pain in the affected area, which can be mistaken for other conditions such as muscle strains or sprains. The ossification process can severely limit joint movement and function, leading to significant disability. Diagnosis is primarily clinical, supported by imaging studies such as X-rays or MRI, which reveal the presence of heterotopic bone formation. Genetic testing may also be utilized to confirm the diagnosis, particularly in atypical cases. Management focuses on symptomatic relief, physical therapy, and avoiding invasive procedures that may exacerbate the condition. Understanding the complexities of MOP is crucial for accurate coding and appropriate patient management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rarity of the condition makes documentation less familiar to coders.
  • Requires understanding of genetic implications and clinical presentation.
  • Differentiation from other myositis conditions can be challenging.
  • Need for precise documentation of location and extent of ossification.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to specify the affected body part.
  • Misinterpretation of imaging results.
  • Lack of genetic testing documentation.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes on physical examination, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with unexplained muscle stiffness and swelling after trauma.

Billing Considerations

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

Genetics

Documentation Requirements

Genetic testing results and family history documentation.

Common Clinical Scenarios

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

Billing Considerations

Ensure that genetic counseling notes are included to support the diagnosis.

Coding Guidelines

Inclusion Criteria

Use M61.161 When
  • According to ICD
  • 10 guidelines, M61
  • 161 should be used when there is confirmed myositis ossificans progressiva localized to the right lower leg
  • Coders must ensure that the diagnosis is supported by clinical documentation and imaging studies

Exclusion Criteria

Do NOT use M61.161 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

Radiologic examination, lower extremity, complete, including hip, femur, tibia, fibula, and knee.

Clinical Scenario

Used when imaging is required to assess for ossification in the lower leg.

Documentation Requirements

Radiology reports must be included to support the diagnosis.

Specialty Considerations

Orthopedic specialists should ensure imaging findings correlate with clinical symptoms.

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 prevalence 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 aids in better understanding the prevalence and management of the condition.

Reimbursement & Billing Impact

reimbursement processes. This specificity aids in better understanding the prevalence and management of the condition.

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 primarily clinical, supported by imaging studies that reveal heterotopic ossification and may include genetic testing to confirm the condition.