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ICD-10 Guide
ICD-10 CodesM61.13

M61.13

Billable

Myositis ossificans progressiva, forearm

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

Code Description

ICD-10 M61.13 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, forearm.

Key Diagnostic Point:

Myositis ossificans progressiva (MOP) is a rare genetic disorder characterized by the abnormal formation of bone in muscles and connective tissues. This condition typically manifests after trauma or injury, leading to progressive ossification of soft tissues, particularly in the forearm and other areas of the body. Patients may experience muscle weakness, stiffness, and limited range of motion as the condition progresses. The ossification process can lead to significant functional impairment, as the affected muscles become increasingly replaced by bone. Diagnosis is often confirmed through imaging studies, such as X-rays or MRI, which reveal the presence of heterotopic ossification. Management of MOP is primarily supportive, focusing on physical therapy and pain management, as surgical intervention is often complicated by the risk of further ossification. Understanding the clinical presentation and progression of myositis ossificans progressiva is crucial for accurate coding and effective patient management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Rarity of the condition makes documentation less common.
  • Requires understanding of both myositis and ossification processes.
  • Differentiation from other muscle disorders can be challenging.
  • Potential for misdiagnosis or coding errors due to overlapping symptoms.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to document the progression of symptoms.
  • Lack of imaging studies to support diagnosis.
  • Misclassification of the condition as a more common muscle disorder.

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 stiffness and swelling after trauma.

Billing Considerations

Documentation should emphasize the genetic nature of the condition and any family history.

Orthopedics

Documentation Requirements

Surgical notes, imaging studies, and post-operative assessments.

Common Clinical Scenarios

Patients requiring surgical intervention for severe ossification.

Billing Considerations

Careful documentation of the risks associated with surgery in patients with MOP.

Coding Guidelines

Inclusion Criteria

Use M61.13 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation and imaging studies
  • Include any relevant history of trauma or genetic predisposition

Exclusion Criteria

Do NOT use M61.13 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 needed due to swelling from ossification.

Documentation Requirements

Document the reason for aspiration and findings during the procedure.

Specialty Considerations

Orthopedic specialists should ensure clear documentation of the condition's impact on joint function.

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 patient records and facilitating better management of the condition.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of myositis ossificans progressiva, improving the accuracy of patient records and facilitating better management of the condition.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of myositis ossificans progressiva, improving the accuracy of patient records and facilitating better management of the condition.

Resources

Clinical References

  • •
    Myositis Ossificans Progressiva Foundation

Coding & Billing References

  • •
    Myositis Ossificans Progressiva Foundation

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, often following trauma.

How is myositis ossificans progressiva diagnosed?

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

What are the treatment options for myositis ossificans progressiva?

Treatment is primarily supportive, focusing on physical therapy and pain management, as surgical options carry risks of further ossification.