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ICD-10 Guide
ICD-10 CodesM61.519

M61.519

Billable

Other ossification of muscle, unspecified shoulder

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

Code Description

ICD-10 M61.519 is a billable code used to indicate a diagnosis of other ossification of muscle, unspecified shoulder.

Key Diagnostic Point:

M61.519 refers to a condition characterized by abnormal bone formation within the muscle tissue of the shoulder region, which is not classified under more specific ossification disorders. This condition can arise from various etiologies, including trauma, myositis, or idiopathic causes. Patients may present with muscle stiffness, pain, and reduced range of motion in the shoulder, which can significantly impact daily activities and quality of life. The ossification process can lead to calcification of muscle fibers, resulting in muscle weakness and functional impairment. Diagnosis typically involves imaging studies such as X-rays or MRI to visualize the ossified areas and differentiate them from other musculoskeletal disorders. Treatment may include physical therapy, pain management, and in some cases, surgical intervention to remove the ossified tissue. Understanding the underlying causes and associated muscle disorders is crucial for effective management and rehabilitation of affected individuals.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Need for differential diagnosis to rule out other conditions
  • Potential for co-existing muscle disorders
  • Documentation requirements for accurate coding

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the location of ossification
  • Misclassification with other muscle disorders
  • Lack of imaging studies to support diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with shoulder pain and limited mobility due to ossification.

Billing Considerations

Ensure clear documentation of the extent of ossification and its impact on function.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, therapy progress notes, and patient-reported outcomes.

Common Clinical Scenarios

Rehabilitation of patients post-surgery for ossification removal.

Billing Considerations

Documenting the impact of muscle weakness on rehabilitation goals.

Coding Guidelines

Inclusion Criteria

Use M61.519 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the condition's specifics
  • Include details on the patient's history, clinical findings, and any imaging results that support the diagnosis

Exclusion Criteria

Do NOT use M61.519 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 for pain management in patients with ossification-related discomfort.

Documentation Requirements

Document the indication for the procedure and any imaging findings.

Specialty Considerations

Orthopedic specialists should ensure clear documentation of the joint involved.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of muscle ossification disorders, improving the accuracy of diagnoses and treatment tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of muscle ossification disorders, improving the accuracy of diagnoses and treatment tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of muscle ossification disorders, improving the accuracy of diagnoses and treatment tracking.

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 symptoms of M61.519?

Common symptoms include shoulder pain, stiffness, and reduced range of motion, often accompanied by muscle weakness.

How is M61.519 diagnosed?

Diagnosis typically involves clinical evaluation, imaging studies such as X-rays or MRI, and exclusion of other muscle disorders.