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ICD-10 Guide
ICD-10 CodesM61.52

M61.52

Billable

Other ossification of muscle, upper arm

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

Code Description

ICD-10 M61.52 is a billable code used to indicate a diagnosis of other ossification of muscle, upper arm.

Key Diagnostic Point:

M61.52 refers to a condition characterized by abnormal ossification or bone formation within the muscle tissue of the upper arm. This condition can arise from various underlying causes, including trauma, repetitive strain, or certain myopathies. The ossification process can lead to stiffness, pain, and reduced range of motion in the affected arm, significantly impacting the patient's functional abilities. Clinically, patients may present with muscle weakness, swelling, and tenderness in the upper arm, and may also experience associated symptoms of myositis or other 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 nuances of this condition is crucial for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating from other muscle disorders such as myositis or muscle strain.
  • Need for precise documentation of the location and extent of ossification.
  • Potential overlap with other ICD-10 codes related to muscle conditions.
  • Variability in clinical presentation and underlying causes.

Audit Risk Factors

  • Inadequate documentation of the clinical findings.
  • Failure to include imaging results in the medical record.
  • Misclassification of the condition due to similar codes.
  • Lack of clear treatment plans or follow-up notes.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with pain and limited mobility in the upper arm following trauma or repetitive use.

Billing Considerations

Ensure that all imaging studies are documented and correlate with clinical findings.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Patients requiring rehabilitation post-surgery for ossification removal or those with chronic pain.

Billing Considerations

Document progress notes meticulously to support ongoing treatment and therapy.

Coding Guidelines

Inclusion Criteria

Use M61.52 When
  • According to ICD
  • 10 coding guidelines, M61
  • 52 should be used when there is clear documentation of ossification in the muscle of the upper arm
  • It is essential to ensure that the condition is not a result of other specified muscle disorders
  • The code should be supported by clinical findings and imaging results

Exclusion Criteria

Do NOT use M61.52 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 joint aspiration is performed due to associated swelling.

Documentation Requirements

Document the reason for aspiration and findings during the procedure.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on clinical findings.

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 M61.52, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like M61.52, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like M61.52, improving the accuracy of diagnoses and treatment plans. This specificity aids in better tracking of patient outcomes and resource allocation.

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 M61.52?

Common symptoms include pain, swelling, stiffness, and reduced range of motion in the upper arm, often accompanied by muscle weakness.

How is M61.52 diagnosed?

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

What treatments are available for M61.52?

Treatment options may include physical therapy, pain management, and in some cases, surgical intervention to remove ossified tissue.