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ICD-10 Guide
ICD-10 CodesM61.111

M61.111

Billable

Myositis ossificans progressiva, right shoulder

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

Code Description

ICD-10 M61.111 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, right shoulder.

Key Diagnostic Point:

Myositis ossificans progressiva (MOP) is a rare genetic disorder characterized by the abnormal formation of bone in muscle tissue, leading to progressive loss of mobility and muscle function. This condition is caused by mutations in the ACVR1 gene, which plays a crucial role in the regulation of bone growth. In patients with MOP, muscle tissue is replaced by bone, particularly after trauma or injury, resulting in stiffness and pain in the affected area. The right shoulder is a common site for this condition, where patients may experience significant muscle weakness and limited range of motion. Diagnosis is typically made through clinical evaluation, imaging studies such as X-rays or MRI, and genetic testing. Management focuses on symptomatic relief, physical therapy, and avoiding trauma to the affected muscles. Surgical intervention may be considered in severe cases, but it carries risks of exacerbating the condition. Understanding the complexities of MOP is essential for accurate coding and appropriate patient management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rare condition with limited awareness among healthcare providers
  • Requires specific genetic testing for diagnosis
  • Differentiation from other myositis conditions is necessary
  • Potential for overlapping symptoms with other neuromuscular disorders

Audit Risk Factors

  • Insufficient documentation of genetic testing results
  • Lack of clarity on the specific muscle group affected
  • Inadequate description of the patient's functional limitations
  • Failure to document the progression of the condition

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical notes on symptoms, physical examination findings, and any imaging or lab results.

Common Clinical Scenarios

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

Billing Considerations

Documentation should include family history and any previous episodes of myositis.

Genetics

Documentation Requirements

Genetic testing results and family pedigree analysis.

Common Clinical Scenarios

Patients with a family history of myositis or unexplained ossification.

Billing Considerations

Ensure that genetic counseling notes are included in the documentation.

Coding Guidelines

Inclusion Criteria

Use M61.111 When
  • Follow the official ICD
  • CM guidelines for coding myositis and muscle disorders
  • Ensure that the documentation supports the diagnosis and specifies the affected site
  • Include any relevant history of trauma or genetic testing

Exclusion Criteria

Do NOT use M61.111 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 for pain management in patients with myositis ossificans.

Documentation Requirements

Document the indication for the procedure and any imaging guidance used.

Specialty Considerations

Rheumatology specialists should ensure that the procedure is justified based on the patient's symptoms.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of myositis ossificans progressiva, improving the accuracy of data collection and reimbursement processes. This specificity aids in better understanding the condition's prevalence and management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of myositis ossificans progressiva, improving the accuracy of data collection and reimbursement processes. This specificity aids in better understanding the condition's prevalence and management.

Reimbursement & Billing Impact

reimbursement processes. This specificity aids in better understanding the condition's prevalence and management.

Resources

Clinical References

  • •
    Myositis Association

Coding & Billing References

  • •
    Myositis Association

Frequently Asked Questions

What is myositis ossificans progressiva?

Myositis ossificans progressiva is a rare genetic disorder characterized by the abnormal formation of bone in muscle tissue, leading to progressive loss of mobility and muscle function.

How is myositis ossificans progressiva diagnosed?

Diagnosis is made through clinical evaluation, imaging studies, and genetic testing to confirm mutations in the ACVR1 gene.

What are the treatment options for myositis ossificans progressiva?

Management focuses on symptomatic relief, physical therapy, and avoiding trauma. Surgical intervention may be considered in severe cases.