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ICD-10 Guide
ICD-10 CodesM61.10

M61.10

Billable

Myositis ossificans progressiva, unspecified site

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

Code Description

ICD-10 M61.10 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, unspecified site.

Key Diagnostic Point:

Myositis ossificans progressiva (MOP) is a rare genetic disorder characterized by the abnormal formation of bone in muscles, tendons, and other connective tissues. This condition is caused by mutations in the ACVR1 gene, which plays a crucial role in the regulation of bone growth and development. Patients with MOP typically experience progressive muscle stiffness and weakness, often beginning in childhood or early adulthood. The hallmark of this condition is the formation of heterotopic ossification, where bone tissue forms in areas where it should not, leading to significant mobility issues and pain. The condition can be triggered by trauma or injury, but it can also occur spontaneously. Diagnosis is primarily clinical, supported by imaging studies such as X-rays or MRIs that reveal abnormal bone growth. Management focuses on symptomatic relief, physical therapy, and avoiding activities that may exacerbate the condition. Surgical intervention is generally avoided due to the risk of further ossification. As the condition progresses, patients may face severe limitations in their range of motion and overall quality of life.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rarity of the condition leading to limited familiarity among coders
  • Need for precise documentation of clinical findings and imaging results
  • Potential for misdiagnosis with other myositis or muscle disorders
  • Genetic testing implications and documentation requirements

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document genetic testing results
  • Misclassification of the condition with other myopathies
  • Lack of clear treatment plans in medical records

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical notes on muscle strength, range of motion, and any imaging studies performed.

Common Clinical Scenarios

Patients presenting with unexplained muscle stiffness and pain, particularly after trauma.

Billing Considerations

Documentation should emphasize the progressive nature of the condition and any genetic testing results.

Genetics

Documentation Requirements

Genetic testing results and family history of similar conditions.

Common Clinical Scenarios

Patients with a family history of myositis ossificans or unexplained ossification.

Billing Considerations

Ensure that genetic counseling notes are included in the medical record.

Coding Guidelines

Inclusion Criteria

Use M61.10 When
  • Follow the official ICD
  • CM coding guidelines for myositis and muscle disorders
  • Ensure that the code is used only when the condition is confirmed and documented appropriately

Exclusion Criteria

Do NOT use M61.10 When
  • Exclude conditions that are not related to myositis ossificans

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used for follow-up visits for management of myositis ossificans progressiva.

Documentation Requirements

Detailed notes on patient history, examination findings, and treatment plans.

Specialty Considerations

Rheumatology or genetics specialists should document their assessments thoroughly.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving data accuracy and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving data accuracy and facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving data accuracy and facilitating better patient management.

Resources

Clinical References

  • •
    Myositis ossificans progressiva: A comprehensive overview

Coding & Billing References

  • •
    Myositis ossificans progressiva: A comprehensive overview

Frequently Asked Questions

What is myositis ossificans progressiva?

Myositis ossificans progressiva is a rare genetic disorder characterized by the abnormal formation of bone in muscles and connective tissues, leading to progressive stiffness and weakness.

How is myositis ossificans progressiva diagnosed?

Diagnosis is based on clinical presentation, family history, imaging studies, and genetic testing for ACVR1 mutations.