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ICD-10 Guide
ICD-10 CodesM61.19

M61.19

Billable

Myositis ossificans progressiva, multiple sites

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

Code Description

ICD-10 M61.19 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, multiple sites.

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 is caused by mutations in the ACVR1 gene, which plays a crucial role in bone and muscle development. Patients with MOP experience progressive muscle weakness and stiffness, often leading to significant functional impairment. The ossification typically occurs in multiple sites, including the neck, shoulders, back, and limbs, and can be triggered by trauma or may occur spontaneously. The condition is often misdiagnosed due to its rarity and the overlap of symptoms with other neuromuscular disorders. Diagnosis is primarily clinical, supported by imaging studies that reveal calcifications in soft tissues. Management focuses on symptomatic relief, physical therapy, and avoiding activities that may trigger ossification. Surgical intervention is generally avoided due to the risk of exacerbating the condition. Understanding the complexities of MOP is essential for accurate coding and effective patient management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Rarity of the condition leading to limited familiarity among coders.
  • Need for precise documentation of multiple sites of ossification.
  • Differentiation from other myositis and muscle disorders.
  • Potential for misdiagnosis and coding errors due to overlapping symptoms.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to specify multiple sites of ossification.
  • Misinterpretation of imaging results.
  • Lack of genetic testing documentation.

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical notes on muscle weakness, stiffness, and any imaging studies performed.

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of the progression of symptoms and any genetic testing results.

Genetics

Documentation Requirements

Genetic testing results and family history documentation.

Common Clinical Scenarios

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

Billing Considerations

Document the specific genetic mutation identified and its implications for treatment.

Coding Guidelines

Inclusion Criteria

Use M61.19 When
  • According to ICD
  • 10 guidelines, M61
  • 19 should be used when there is clear documentation of myositis ossificans progressiva affecting multiple sites
  • Coders should ensure that the diagnosis is confirmed by imaging studies and that the clinical documentation supports the diagnosis

Exclusion Criteria

Do NOT use M61.19 When
No specific exclusions found.

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 history and examination notes reflecting the patient's condition.

Specialty Considerations

Rheumatology or genetics specialists should document the progression of symptoms and treatment plans.

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 data accuracy and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving data accuracy and facilitating better patient management.

Reimbursement & Billing Impact

reimbursement.

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 muscle weakness and stiffness.

How is myositis ossificans progressiva diagnosed?

Diagnosis is primarily clinical, supported by imaging studies that reveal calcifications in soft tissues and confirmed by genetic testing for ACVR1 mutations.