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ICD-10 Guide
ICD-10 CodesM61.01

M61.01

Billable

Myositis ossificans traumatica, shoulder

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

Code Description

ICD-10 M61.01 is a billable code used to indicate a diagnosis of myositis ossificans traumatica, shoulder.

Key Diagnostic Point:

Myositis ossificans traumatica of the shoulder is a condition characterized by the abnormal formation of bone tissue within the muscle following trauma. This condition typically arises after a significant injury, such as a fracture or severe contusion, leading to inflammation of the muscle (myositis) and subsequent ossification. The shoulder is a common site for this condition due to its mobility and susceptibility to injuries. Patients may present with localized pain, swelling, and reduced range of motion in the shoulder. Diagnosis is often confirmed through imaging studies, such as X-rays or MRI, which reveal calcification or bone formation within the muscle tissue. Treatment may involve physical therapy, pain management, and in some cases, surgical intervention to remove the ossified tissue if it leads to significant functional impairment. Understanding the underlying mechanisms of myositis ossificans is crucial for effective management and rehabilitation of affected individuals.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of trauma-related conditions
  • Differentiation from other types of myositis
  • Need for precise documentation of the injury mechanism
  • Potential for co-existing conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of the traumatic event
  • Failure to specify the location of ossification
  • Misclassification of myositis types
  • Lack of imaging reports to support diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed injury history, imaging results, and treatment plans.

Common Clinical Scenarios

Post-traumatic shoulder pain, limited range of motion after injury.

Billing Considerations

Ensure clear documentation of the mechanism of injury and any surgical interventions.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, therapy progress notes, and patient response to treatment.

Common Clinical Scenarios

Rehabilitation following shoulder trauma, management of pain and mobility.

Billing Considerations

Document the impact of myositis ossificans on functional abilities and rehabilitation goals.

Coding Guidelines

Inclusion Criteria

Use M61.01 When
  • Follow ICD
  • CM guidelines for coding myositis ossificans, ensuring accurate documentation of the traumatic event and location
  • Include any relevant external cause codes if applicable

Exclusion Criteria

Do NOT use M61.01 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration of shoulder joint

Clinical Scenario

Used when fluid accumulation is suspected in conjunction with myositis ossificans.

Documentation Requirements

Document the reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between aspiration and diagnosis.

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 myositis ossificans, improving the accuracy of diagnoses and treatment tracking. This specificity aids in better patient management and resource allocation.

ICD-9 vs ICD-10

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

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like myositis ossificans, improving the accuracy of diagnoses and treatment tracking. This specificity aids in better patient management 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 is myositis ossificans traumatica?

Myositis ossificans traumatica is a condition where bone tissue forms in muscle after a traumatic injury, often leading to pain and limited mobility.

How is myositis ossificans diagnosed?

Diagnosis typically involves a combination of patient history, physical examination, and imaging studies such as X-rays or MRI to identify calcification in the muscle.