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ICD-10 Guide
ICD-10 CodesM61.172

M61.172

Billable

Myositis ossificans progressiva, left ankle

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

Code Description

ICD-10 M61.172 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, left ankle.

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 typically presents with progressive muscle weakness and stiffness, often beginning in childhood or early adulthood. In the case of M61.172, the ossification occurs specifically in the left ankle region, leading to significant functional impairment. Patients may experience episodes of swelling, pain, and limited range of motion in the affected area. The underlying pathophysiology involves mutations in the ACVR1 gene, which plays a crucial role in bone morphogenetic protein (BMP) signaling, leading to inappropriate bone formation in soft tissues. Diagnosis is primarily clinical, supported by imaging studies that reveal heterotopic ossification. Management focuses on symptomatic relief, physical therapy, and avoiding invasive procedures that may exacerbate 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
  • Specificity required for anatomical location (left ankle)
  • Potential for misdiagnosis with other muscle disorders
  • Need for genetic testing documentation

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to specify the anatomical site of ossification
  • Misclassification with other types of myositis
  • Lack of detailed clinical notes on patient symptoms

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical history, physical examination findings, and imaging results.

Common Clinical Scenarios

Patients presenting with progressive muscle weakness and pain in the left ankle.

Billing Considerations

Ensure documentation reflects the genetic basis of the condition and any associated comorbidities.

Genetics

Documentation Requirements

Genetic testing results and family history of myositis ossificans.

Common Clinical Scenarios

Patients with a family history of MOP or unexplained ossification.

Billing Considerations

Document the specific genetic mutations identified and their implications for treatment.

Coding Guidelines

Inclusion Criteria

Use M61.172 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the condition's specifics, including the anatomical site and any associated symptoms

Exclusion Criteria

Do NOT use M61.172 When
  • Exclude conditions that do not meet the criteria for myositis ossificans progressiva

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits for management of MOP.

Documentation Requirements

Document history, examination, and medical decision-making.

Specialty Considerations

Rheumatology and genetics specialties may require additional documentation related to genetic testing.

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 the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 muscle weakness and stiffness.

How is M61.172 diagnosed?

Diagnosis of M61.172 involves clinical evaluation, imaging studies to identify ossification, and genetic testing to confirm mutations in the ACVR1 gene.