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ICD-10 Guide
ICD-10 CodesM61.04

M61.04

Billable

Myositis ossificans traumatica, hand

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

Code Description

ICD-10 M61.04 is a billable code used to indicate a diagnosis of myositis ossificans traumatica, hand.

Key Diagnostic Point:

Myositis ossificans traumatica is a condition characterized by the abnormal formation of bone tissue within muscle or connective tissue following trauma. In the case of the hand, this condition typically arises after an injury, such as a fracture or severe contusion, leading to inflammation and subsequent ossification. The process begins with muscle inflammation (myositis), which can result in pain, swelling, and limited range of motion. Over time, the inflammatory response can lead to the deposition of calcium salts in the muscle tissue, resulting in the formation of bone-like structures. Clinically, patients may present with muscle weakness, stiffness, and functional impairment of the hand. Diagnosis is often confirmed through imaging studies, such as X-rays or MRI, which reveal the presence of heterotopic ossification. Treatment may involve physical therapy, pain management, and in some cases, surgical intervention to remove the ossified tissue. Understanding the nuances of myositis ossificans is crucial for effective management and rehabilitation of affected patients.

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 cases following fractures or soft tissue injuries.

Billing Considerations

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

Physical Medicine and Rehabilitation

Documentation Requirements

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

Common Clinical Scenarios

Rehabilitation following surgical excision of ossified tissue.

Billing Considerations

Focus on documenting functional limitations and rehabilitation goals.

Coding Guidelines

Inclusion Criteria

Use M61.04 When
  • According to ICD
  • 10 guidelines, M61
  • 04 should be used when there is clear documentation of myositis ossificans resulting from trauma specifically in the hand
  • Ensure that the diagnosis is supported by imaging and clinical findings

Exclusion Criteria

Do NOT use M61.04 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 swelling from myositis ossificans.

Documentation Requirements

Document the reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between the procedure and the 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 plans. M61.04 provides a clear distinction for trauma-related ossification, which was less defined in ICD-9.

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 plans. M61.04 provides a clear distinction for trauma-related ossification, which was less defined in ICD-9.

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 plans. M61.04 provides a clear distinction for trauma-related ossification, which was less defined in ICD-9.

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 myositis ossificans traumatica?

The primary cause is trauma to the muscle, which leads to inflammation and abnormal bone formation in the affected area.

How is myositis ossificans diagnosed?

Diagnosis is typically made through clinical evaluation and imaging studies, such as X-rays or MRI, which reveal the presence of ossification.

What are the treatment options for myositis ossificans?

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