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ICD-10 Guide
ICD-10 CodesM61.121

M61.121

Billable

Myositis ossificans progressiva, right upper arm

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

Code Description

ICD-10 M61.121 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, right upper arm.

Key Diagnostic Point:

Myositis ossificans progressiva (MOP) is a rare genetic disorder characterized by the abnormal formation of bone in muscle and connective tissues. This condition typically presents in early childhood and is marked by episodes of painful swelling and stiffness in the affected muscles, often leading to significant muscle weakness and reduced mobility. In the case of M61.121, the condition specifically affects the right upper arm, which may result in limited range of motion and functional impairment. The pathophysiology involves a mutation in the ACVR1 gene, leading to dysregulation of bone morphogenetic proteins (BMPs) that promote ossification. Diagnosis is primarily clinical, supported by imaging studies that reveal heterotopic ossification. Management focuses on symptomatic relief, physical therapy, and avoiding trauma to the affected areas, as injury can exacerbate ossification. Understanding the complexities of this condition is crucial for accurate coding and appropriate patient management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rarity of the condition makes documentation less familiar to providers.
  • Specificity required in identifying the affected body part (right upper arm).
  • Potential for confusion with other myositis or ossification disorders.
  • Need for genetic testing documentation to confirm diagnosis.

Audit Risk Factors

  • Inadequate documentation of the genetic basis of the condition.
  • Failure to specify the affected body part.
  • Misclassification with other types of myositis.
  • Lack of supporting imaging studies in the medical record.

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed history of symptoms, physical examination findings, and imaging results.

Common Clinical Scenarios

Patients presenting with unexplained muscle pain and swelling, particularly in the upper extremities.

Billing Considerations

Documentation should emphasize the genetic component and any family history of similar conditions.

Genetics

Documentation Requirements

Genetic testing results and family pedigree analysis.

Common Clinical Scenarios

Patients with a family history of myositis ossificans or related disorders seeking genetic counseling.

Billing Considerations

Ensure that genetic testing results are clearly documented to support the diagnosis.

Coding Guidelines

Inclusion Criteria

Use M61.121 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the condition's specifics, including the affected body part and any relevant clinical findings
  • Include any relevant family history and genetic testing results

Exclusion Criteria

Do NOT use M61.121 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Office or other outpatient visit, established patient

Clinical Scenario

Used for follow-up visits to monitor the patient's condition.

Documentation Requirements

Document the patient's history, examination findings, and any changes in treatment.

Specialty Considerations

Rheumatologists should ensure that the visit details reflect the complexity of managing myositis ossificans.

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 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 muscle and connective tissues, leading to progressive stiffness and functional impairment.