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ICD-10 Guide
ICD-10 CodesM61.178

M61.178

Billable

Myositis ossificans progressiva, left toe(s)

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

Code Description

ICD-10 M61.178 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, left toe(s).

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 in early childhood and progresses over time, leading to significant muscle stiffness and weakness. In the case of M61.178, the ossification specifically affects the left toe(s), which can result in pain, limited mobility, and functional impairment. The underlying pathophysiology involves mutations in the ACVR1 gene, which plays a crucial role in bone morphogenetic protein (BMP) signaling. Patients may experience episodes of soft tissue swelling followed by the development of heterotopic ossification, where bone forms in areas where it normally does not exist. Diagnosis is often confirmed through imaging studies, such as X-rays or MRI, which reveal the presence of abnormal bone formation. Management typically focuses on symptomatic relief, physical therapy, and avoiding trauma to affected areas to prevent exacerbation of the condition.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rare condition requiring specialized knowledge for accurate coding.
  • Potential for misdiagnosis due to overlapping symptoms with other myopathies.
  • Need for precise documentation of affected areas and symptoms.
  • Genetic testing may be required for definitive diagnosis, complicating coding.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to specify the affected area (left toe(s)).
  • Lack of genetic testing results in the medical record.
  • Misalignment between clinical notes and coded diagnosis.

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical notes on symptoms, family history, and genetic testing results.

Common Clinical Scenarios

Patients presenting with progressive muscle weakness and stiffness, particularly in the extremities.

Billing Considerations

Rheumatologists should be aware of the genetic basis of the condition and document any relevant family history.

Genetics

Documentation Requirements

Comprehensive genetic testing results and family pedigree charts.

Common Clinical Scenarios

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

Billing Considerations

Geneticists must ensure that the documentation clearly links the genetic findings to the clinical diagnosis.

Coding Guidelines

Inclusion Criteria

Use M61.178 When
  • According to ICD
  • 10 coding guidelines, M61
  • 178 should be used when there is clear documentation of myositis ossificans progressiva affecting the left toe(s)
  • Coders should ensure that the diagnosis is supported by clinical findings and imaging studies

Exclusion Criteria

Do NOT use M61.178 When
  • Exclusion criteria include other forms of myositis or conditions causing similar symptoms

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.

Documentation Requirements

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

Specialty Considerations

Rheumatologists should document the progression of symptoms and response to therapy.

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 muscles and connective tissues, leading to progressive stiffness and weakness.

How is myositis ossificans progressiva diagnosed?

Diagnosis is primarily clinical, supported by imaging studies that reveal abnormal bone formation, and can be confirmed through genetic testing for ACVR1 mutations.