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ICD-10 Guide
ICD-10 CodesM61.039

M61.039

Billable

Myositis ossificans traumatica, unspecified forearm

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

Code Description

ICD-10 M61.039 is a billable code used to indicate a diagnosis of myositis ossificans traumatica, unspecified forearm.

Key Diagnostic Point:

Myositis ossificans traumatica is a condition characterized by the abnormal formation of bone tissue within muscle or connective tissue following trauma. This condition typically occurs after a significant injury, such as fractures, muscle strains, or contusions, leading to inflammation and subsequent ossification. In the case of unspecified forearm involvement, the condition may manifest as localized pain, swelling, and reduced range of motion in the affected area. Patients may experience muscle weakness due to the disruption of normal muscle function and the presence of ectopic bone formation. Diagnosis is often confirmed through imaging studies, such as X-rays or MRI, which reveal the presence of calcified areas within the muscle. Treatment may include physical therapy, pain management, and in some cases, surgical intervention to remove the ossified tissue. Understanding the nuances of myositis ossificans is crucial for accurate coding and appropriate management of the condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of symptoms
  • Need for precise documentation of trauma history
  • Differentiation from other musculoskeletal conditions
  • Potential for co-existing conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of trauma history
  • Failure to specify the affected muscle group
  • Misclassification of myositis ossificans as other conditions
  • Lack of imaging studies to support diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of trauma, imaging results, and treatment plans.

Common Clinical Scenarios

Post-traumatic cases following fractures or sports injuries.

Billing Considerations

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

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, treatment progress notes, and rehabilitation plans.

Common Clinical Scenarios

Patients undergoing rehabilitation post-injury with myositis ossificans.

Billing Considerations

Document the impact on functional abilities and any adaptive strategies employed.

Coding Guidelines

Inclusion Criteria

Use M61.039 When
  • According to ICD
  • 10 guidelines, myositis ossificans is classified under muscle disorders
  • Coders should ensure accurate documentation of the trauma history and specify the affected area to avoid ambiguity

Exclusion Criteria

Do NOT use M61.039 When
  • Exclusion criteria include conditions that do not involve ossification

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 needed due to swelling from myositis ossificans.

Documentation Requirements

Document the reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists may frequently perform this procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding myositis ossificans, improving the accuracy of claims and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding myositis ossificans, improving the accuracy of claims and facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding myositis ossificans, improving the accuracy of claims and facilitating better patient management.

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 within muscle tissue following trauma, leading to pain and functional impairment.