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ICD-10 Guide
ICD-10 CodesM61.469

M61.469

Billable

Other calcification of muscle, unspecified lower leg

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

Code Description

ICD-10 M61.469 is a billable code used to indicate a diagnosis of other calcification of muscle, unspecified lower leg.

Key Diagnostic Point:

M61.469 refers to a condition characterized by abnormal calcification in the muscles of the lower leg, which can occur due to various underlying factors such as trauma, metabolic disorders, or inflammatory conditions. This calcification can lead to muscle stiffness, pain, and weakness, impacting mobility and overall function. The condition may be associated with myositis, which is inflammation of the muscle tissue, and can result in muscle weakness and neuromuscular dysfunction. Patients may present with symptoms such as localized pain, swelling, and reduced range of motion in the affected area. Diagnosis typically involves imaging studies, such as X-rays or MRI, to visualize the calcified areas and assess the extent of muscle involvement. Treatment may include physical therapy, pain management, and addressing any underlying conditions contributing to the calcification. Accurate coding is essential for appropriate management and reimbursement, as well as for tracking the prevalence of this condition in clinical practice.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and underlying causes
  • Need for precise documentation of symptoms and imaging results
  • Differentiation from other muscle disorders and calcifications
  • Potential for co-existing conditions that complicate coding

Audit Risk Factors

  • Insufficient documentation of the underlying cause of calcification
  • Lack of imaging reports to support the diagnosis
  • Inconsistent coding of co-existing conditions
  • Failure to document the impact on muscle function

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed history of symptoms, imaging studies, and treatment plans.

Common Clinical Scenarios

Patients presenting with muscle pain and stiffness, particularly in the context of autoimmune disorders.

Billing Considerations

Documentation should clearly outline the relationship between calcification and any underlying rheumatologic conditions.

Orthopedics

Documentation Requirements

Comprehensive assessment of muscle function, imaging results, and treatment interventions.

Common Clinical Scenarios

Patients with calcification following trauma or surgery, requiring rehabilitation.

Billing Considerations

Focus on functional outcomes and the impact of calcification on mobility.

Coding Guidelines

Inclusion Criteria

Use M61.469 When
  • According to ICD
  • 10 guidelines, M61
  • 469 should be used when there is evidence of calcification in the muscle of the lower leg without a more specific diagnosis
  • Coders must ensure that the documentation supports the diagnosis and that all relevant clinical information is included

Exclusion Criteria

Do NOT use M61.469 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

Radiologic examination, lower extremity, complete, including multiple views.

Clinical Scenario

Used when imaging is required to assess calcification in the lower leg muscles.

Documentation Requirements

Imaging reports must be included in the patient's medical record.

Specialty Considerations

Orthopedic specialists may frequently order these imaging studies.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of muscle calcification, improving the accuracy of data collection and reimbursement processes. M61.469 provides a clear designation for calcification in the lower leg, which was less specific in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of muscle calcification, improving the accuracy of data collection and reimbursement processes. M61.469 provides a clear designation for calcification in the lower leg, which was less specific in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. M61.469 provides a clear designation for calcification in the lower leg, which was less specific in ICD-9.

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, metabolic disorders such as hyperparathyroidism, and inflammatory conditions like myositis. Each of these can lead to abnormal calcium deposition in muscle tissue.