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ICD-10 Guide
ICD-10 CodesM61.542

M61.542

Billable

Other ossification of muscle, left hand

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

Code Description

ICD-10 M61.542 is a billable code used to indicate a diagnosis of other ossification of muscle, left hand.

Key Diagnostic Point:

M61.542 refers to a condition characterized by abnormal bone formation within the muscle tissue of the left hand. This ossification can occur due to various factors, including trauma, inflammation, or certain myopathies. The condition may lead to muscle stiffness, reduced range of motion, and pain, significantly impacting the patient's functional abilities. In some cases, it may be associated with myositis, where muscle inflammation contributes to the ossification process. Patients may experience muscle weakness and discomfort, which can complicate rehabilitation efforts. Diagnosis typically involves imaging studies, such as X-rays or MRI, to visualize the ossified areas and differentiate them from other muscle disorders. Treatment options may include physical therapy, pain management, and in severe cases, surgical intervention to remove the ossified tissue. Accurate coding of this condition is essential for proper reimbursement and to ensure that the patient's medical history reflects the complexity of their condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of symptoms
  • Need for precise documentation of muscle involvement and location
  • Differentiation from other muscle disorders and ossification conditions
  • Potential for associated conditions like myositis or muscle weakness

Audit Risk Factors

  • Inadequate documentation of the clinical rationale for ossification
  • Failure to specify the exact muscle involved
  • Lack of imaging results in the medical record
  • Misclassification of the condition as a different muscle disorder

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 stiffness in the left hand, particularly after trauma or surgery.

Billing Considerations

Documentation should clearly outline the impact of ossification on function and any surgical interventions performed.

Rheumatology

Documentation Requirements

Comprehensive history of inflammatory conditions, lab results, and response to treatment.

Common Clinical Scenarios

Patients with underlying inflammatory myopathies presenting with muscle weakness and ossification.

Billing Considerations

Consideration of systemic symptoms and potential autoimmune conditions that may contribute to muscle ossification.

Coding Guidelines

Inclusion Criteria

Use M61.542 When
  • According to ICD
  • 10 guidelines, M61
  • 542 should be used when there is clear documentation of ossification in the left hand muscle
  • It is important to ensure that the condition is not a result of a more generalized disorder or a different etiology

Exclusion Criteria

Do NOT use M61.542 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 pain due to muscle ossification.

Documentation Requirements

Document the reason for the procedure, including symptoms and imaging findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on the patient's condition.

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 M61.542, improving the accuracy of patient records and facilitating better reimbursement processes. The granularity of ICD-10 codes helps in capturing the complexity of muscle disorders.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like M61.542, improving the accuracy of patient records and facilitating better reimbursement processes. The granularity of ICD-10 codes helps in capturing the complexity of muscle disorders.

Reimbursement & Billing Impact

reimbursement processes. The granularity of ICD-10 codes helps in capturing the complexity of muscle disorders.

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 is the primary cause of ossification in muscle?

Ossification in muscle can be caused by trauma, inflammation, or certain myopathies. It may also occur post-surgically or due to repetitive strain injuries.