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ICD-10 Guide
ICD-10 CodesM61.5

M61.5

Billable

Other ossification of muscle

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

Code Description

ICD-10 M61.5 is a billable code used to indicate a diagnosis of other ossification of muscle.

Key Diagnostic Point:

Other ossification of muscle refers to the abnormal formation of bone tissue within muscle, which can occur due to various underlying conditions. This ossification can lead to muscle stiffness, pain, and reduced range of motion. It is often associated with conditions such as myositis, where inflammation of the muscle tissue can trigger calcification and ossification processes. Patients may present with muscle weakness and discomfort, particularly in the affected areas. The condition can arise from trauma, prolonged immobilization, or as a complication of certain neuromuscular disorders. Diagnosis typically involves imaging studies, such as X-rays or MRI, to visualize the ossified areas and differentiate them from other muscle disorders. Treatment may include physical therapy, pain management, and in some cases, surgical intervention to remove the ossified tissue. Understanding the etiology and clinical implications of this condition is crucial for effective management and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying conditions leading to ossification
  • Differentiation from other muscle disorders
  • Need for precise documentation of symptoms and imaging results
  • Potential for co-existing conditions that complicate coding

Audit Risk Factors

  • Inadequate documentation of the underlying cause of ossification
  • Failure to specify the affected muscle group
  • Misclassification of ossification as a primary diagnosis
  • Lack of imaging reports to support the diagnosis

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed history of muscle symptoms, imaging results, and treatment plans.

Common Clinical Scenarios

Patients with myositis presenting with ossification, or those with chronic inflammatory conditions.

Billing Considerations

Ensure clarity in distinguishing between primary muscle disorders and secondary ossification.

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients requiring surgical intervention for removal of ossified tissue.

Billing Considerations

Document the extent of ossification and its impact on mobility and function.

Coding Guidelines

Inclusion Criteria

Use M61.5 When
  • According to ICD
  • 10 guidelines, M61
  • 5 should be used when there is clear documentation of ossification of muscle not classified elsewhere
  • It is important to ensure that the condition is not a result of trauma or other specified conditions that have their own codes

Exclusion Criteria

Do NOT use M61.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used when treating associated joint issues in patients with muscle ossification.

Documentation Requirements

Document the joint involved and the reason for the procedure.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between muscle and joint conditions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like M61.5, improving the accuracy of diagnoses and treatment plans. This specificity helps in better tracking of muscle disorders and their outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like M61.5, improving the accuracy of diagnoses and treatment plans. This specificity helps in better tracking of muscle disorders and their outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like M61.5, improving the accuracy of diagnoses and treatment plans. This specificity helps in better tracking of muscle disorders and their outcomes.

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 ossification of muscle?

Common causes include myositis, trauma, prolonged immobilization, and certain neuromuscular disorders. Each of these can lead to abnormal bone formation within muscle tissue.