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ICD-10 Guide
ICD-10 CodesM61.17

M61.17

Billable

Myositis ossificans progressiva, ankle, foot and toe(s)

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

Code Description

ICD-10 M61.17 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, ankle, foot and toe(s).

Key Diagnostic Point:

Myositis ossificans progressiva (MOP) is a rare genetic disorder characterized by the abnormal formation of bone in muscles and 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 M61.17, the ossification occurs specifically in the ankle, foot, and toe regions, which can severely impact a patient's ability to walk and 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, pain, and stiffness in the affected areas, often triggered by minor injuries or physical activity. Diagnosis is primarily clinical, supported by imaging studies that reveal abnormal bone formation. Management focuses on symptomatic relief and physical therapy, as surgical interventions can exacerbate the condition. Understanding the complexities of MOP is essential for accurate coding and appropriate patient care.

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 symptoms and progression
  • Potential for misdiagnosis with other myositis conditions
  • Variability in clinical presentation requiring detailed coding

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to specify the affected anatomical sites
  • Misinterpretation of symptoms leading to incorrect coding
  • Lack of clarity in the progression of the condition

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical history, including onset, progression, and treatment response.

Common Clinical Scenarios

Patients presenting with unexplained muscle stiffness and swelling.

Billing Considerations

Ensure genetic testing results are documented to support diagnosis.

Orthopedics

Documentation Requirements

Imaging studies showing ossification and detailed surgical history if applicable.

Common Clinical Scenarios

Patients requiring surgical intervention for mobility issues.

Billing Considerations

Document any exacerbation of symptoms post-surgery.

Coding Guidelines

Inclusion Criteria

Use M61.17 When
  • According to ICD
  • 10 coding guidelines, M61
  • 17 should be used when myositis ossificans progressiva is confirmed in the ankle, foot, and toe(s)
  • Coders must ensure that the documentation supports the diagnosis and includes details about the affected areas and any associated symptoms

Exclusion Criteria

Do NOT use M61.17 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits to monitor MOP symptoms.

Documentation Requirements

Document patient history, examination findings, and treatment plan.

Specialty Considerations

Rheumatology and orthopedics may require additional details on functional status.

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 understanding the prevalence and management of this rare 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 understanding the prevalence and management of this rare condition.

Reimbursement & Billing Impact

reimbursement processes. This specificity helps in understanding the prevalence and management of this rare 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 disability.

How is M61.17 diagnosed?

Diagnosis is based on clinical evaluation, imaging studies, and genetic testing to confirm mutations in the ACVR1 gene.

What are the common symptoms of M61.17?

Common symptoms include muscle weakness, stiffness, and episodes of swelling in the affected areas.

What is the management approach for M61.17?

Management focuses on physical therapy, pain management, and avoiding surgical interventions that may exacerbate the condition.