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ICD-10 Guide
ICD-10 CodesM61.174

M61.174

Billable

Myositis ossificans progressiva, right foot

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

Code Description

ICD-10 M61.174 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, right foot.

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 M61.174, the ossification specifically affects the right foot, leading to significant functional impairment. Patients may experience episodes of swelling and pain in the affected area, which can be mistaken for other inflammatory conditions. The ossification process can severely restrict mobility and lead to complications such as joint deformities. Diagnosis is primarily clinical, supported by imaging studies that reveal calcification in soft tissues. Genetic testing may confirm the diagnosis by identifying mutations in the ACVR1 gene, which is responsible for the condition. Management focuses on symptomatic relief, physical therapy, and avoiding trauma to the affected area, as injury can exacerbate ossification. Surgical intervention is rarely indicated and is approached with caution due to the risk of further ossification.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rarity of the condition leading to limited coding resources.
  • Need for precise documentation of symptoms and imaging findings.
  • Potential for misdiagnosis with other myositis or muscle disorders.
  • Complexity in distinguishing between acute and chronic presentations.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to document genetic testing results.
  • Misclassification of the condition as a more common myositis.
  • Lack of detailed treatment plans in the medical record.

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical notes on symptoms, physical examination findings, and imaging results.

Common Clinical Scenarios

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

Billing Considerations

Consideration of genetic counseling and testing for family members.

Orthopedics

Documentation Requirements

Surgical notes if intervention is performed, imaging studies, and rehabilitation plans.

Common Clinical Scenarios

Patients requiring surgical evaluation for joint stiffness or deformity.

Billing Considerations

Careful assessment of the risks of surgery due to potential for further ossification.

Coding Guidelines

Inclusion Criteria

Use M61.174 When
  • Follow the official ICD
  • CM coding guidelines for myositis and muscle disorders
  • Ensure accurate documentation of the condition's specifics, including laterality and any associated symptoms

Exclusion Criteria

Do NOT use M61.174 When
  • Exclude conditions that may mimic MOP

Related ICD-10 Codes

Related CPT Codes

97001CPT Code

Physical therapy evaluation

Clinical Scenario

Used for assessing functional limitations due to myositis ossificans.

Documentation Requirements

Detailed evaluation of muscle strength and range of motion.

Specialty Considerations

Rheumatology may require specific assessments related to inflammatory conditions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving the accuracy of data collection and reimbursement processes. It has also highlighted the need for detailed documentation to support the complexity of such diagnoses.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving the accuracy of data collection and reimbursement processes. It has also highlighted the need for detailed documentation to support the complexity of such diagnoses.

Reimbursement & Billing Impact

reimbursement processes. It has also highlighted the need for detailed documentation to support the complexity of such diagnoses.

Resources

Clinical References

  • •
    Myositis ossificans progressiva: A clinical overview

Coding & Billing References

  • •
    Myositis ossificans progressiva: A clinical 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.