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ICD-10 Guide
ICD-10 CodesM61.429

M61.429

Billable

Other calcification of muscle, unspecified upper arm

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

Code Description

ICD-10 M61.429 is a billable code used to indicate a diagnosis of other calcification of muscle, unspecified upper arm.

Key Diagnostic Point:

M61.429 refers to the condition characterized by abnormal calcification in the muscle tissue of the upper arm, which is not classified under more specific categories. Calcification can occur due to various underlying conditions, including myositis, which is inflammation of the muscle, or as a result of trauma, metabolic disorders, or chronic diseases. Patients may present with muscle weakness, pain, or stiffness in the affected area. The calcification can lead to impaired muscle function and may be associated with neuromuscular conditions that affect muscle strength and coordination. Diagnosis typically involves imaging studies such as X-rays or MRI to visualize the calcified areas, alongside a thorough clinical evaluation to determine the underlying cause. Treatment may vary depending on the etiology and severity of symptoms, ranging from physical therapy to surgical intervention in severe cases. Accurate coding is essential for proper management and reimbursement, as it reflects the complexity of the patient's condition and guides treatment decisions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and underlying causes of calcification
  • Need for comprehensive documentation to support diagnosis
  • Differentiation from other muscle disorders and calcification types
  • Potential for co-existing conditions that complicate coding

Audit Risk Factors

  • Insufficient documentation of the underlying cause of calcification
  • Failure to specify the muscle group affected
  • Inconsistent coding with clinical findings
  • Lack of imaging studies to support diagnosis

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed history of symptoms, physical examination findings, and imaging results.

Common Clinical Scenarios

Patients presenting with muscle pain and weakness, suspected myositis, or calcification due to autoimmune conditions.

Billing Considerations

Consideration of systemic conditions that may contribute to muscle calcification.

Orthopedics

Documentation Requirements

Surgical notes, imaging studies, and post-operative assessments.

Common Clinical Scenarios

Patients with calcification following trauma or surgery in the upper arm.

Billing Considerations

Documentation of functional impairment and treatment outcomes is critical.

Coding Guidelines

Inclusion Criteria

Use M61.429 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the code is used only when the calcification is confirmed and documented
  • Include any relevant history or clinical findings that support the diagnosis

Exclusion Criteria

Do NOT use M61.429 When
  • Exclude conditions that are more specifically defined in other codes

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

X-ray, upper arm

Clinical Scenario

Used to confirm calcification in the upper arm muscles.

Documentation Requirements

Include imaging results and clinical findings.

Specialty Considerations

Orthopedic specialists should document the rationale for imaging.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of muscle conditions, including calcification. M61.429 provides a clear designation for muscle calcification in the upper arm, which aids in treatment planning and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of muscle conditions, including calcification. M61.429 provides a clear designation for muscle calcification in the upper arm, which aids in treatment planning and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of muscle calcification?

Common causes include trauma, myositis, metabolic disorders, and chronic inflammatory conditions. Each cause may require different treatment approaches.