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v1.0.0
ICD-10 Guide
ICD-10 CodesM61.179

M61.179

Billable

Myositis ossificans progressiva, unspecified toe(s)

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

Code Description

ICD-10 M61.179 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, unspecified 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 unspecified toe(s), the ossification may occur in the muscles surrounding the toes, resulting in stiffness and pain. Patients may experience episodes of inflammation and swelling in the affected areas, which can further complicate mobility. The condition is caused by mutations in the ACVR1 gene, which plays a crucial role in bone and muscle development. Diagnosis is often confirmed through clinical evaluation, imaging studies, and genetic testing. Management focuses on symptomatic relief, physical therapy, and avoiding activities that may exacerbate the condition. Due to the progressive nature of MOP, early intervention is critical to maintaining function and quality of life.

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
  • Requirement for genetic testing documentation

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to specify the affected area (e.g., toe(s))
  • Misclassification of the condition as a more common myositis type
  • Lack of detailed clinical notes on progression and treatment

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical notes on symptoms, progression, and treatment plans.

Common Clinical Scenarios

Patients presenting with muscle weakness, pain, and restricted mobility.

Billing Considerations

Documentation should include genetic testing results and any imaging studies performed.

Genetics

Documentation Requirements

Genetic testing results and family history of similar conditions.

Common Clinical Scenarios

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

Billing Considerations

Ensure that genetic counseling notes are included in the documentation.

Coding Guidelines

Inclusion Criteria

Use M61.179 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the condition is confirmed
  • Document the specific affected areas and any relevant clinical findings
  • existing

Exclusion Criteria

Do NOT use M61.179 When
  • Exclude other myositis conditions unless they are co

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used for follow-up visits for patients with MOP.

Documentation Requirements

Document history, examination findings, and treatment plan.

Specialty Considerations

Rheumatology and genetics specialties may have specific documentation needs.

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 data accuracy and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving data accuracy and facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving data accuracy and facilitating better patient management.

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.