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ICD-10 Guide
ICD-10 CodesM61.42

M61.42

Billable

Other calcification of muscle, upper arm

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

Code Description

ICD-10 M61.42 is a billable code used to indicate a diagnosis of other calcification of muscle, upper arm.

Key Diagnostic Point:

M61.42 refers to a condition characterized by abnormal calcification in the muscles of the upper arm, which can lead to various muscle disorders. This calcification may occur due to a variety of underlying conditions, including myositis, which is inflammation of the muscle tissue, and can result in muscle weakness and pain. The calcification can be a result of trauma, metabolic disorders, or idiopathic causes. Patients may present with symptoms such as localized swelling, tenderness, and restricted range of motion in the affected arm. The condition can be diagnosed through imaging studies, such as X-rays or MRI, which reveal the presence of calcified deposits within the muscle tissue. Treatment may involve physical therapy, pain management, and in some cases, surgical intervention to remove the calcified tissue. Understanding the etiology and implications of muscle calcification is crucial for effective management and rehabilitation of affected patients.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes leading to calcification
  • Differentiation from other muscle disorders
  • Need for precise documentation of symptoms and imaging results
  • Potential for co-morbid conditions affecting muscle function

Audit Risk Factors

  • Inadequate documentation of symptoms and imaging findings
  • Failure to specify the underlying cause of calcification
  • Misclassification of muscle disorders
  • Inconsistent coding practices among providers

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, treatment plans, and follow-up notes.

Common Clinical Scenarios

Patients presenting with pain and limited mobility in the upper arm due to calcification.

Billing Considerations

Ensure that the underlying cause of calcification is documented to support the diagnosis.

Rheumatology

Documentation Requirements

Comprehensive history of autoimmune conditions, lab results, and treatment responses.

Common Clinical Scenarios

Patients with myositis or other inflammatory conditions leading to muscle calcification.

Billing Considerations

Document any systemic symptoms that may indicate an underlying rheumatologic condition.

Coding Guidelines

Inclusion Criteria

Use M61.42 When
  • According to ICD
  • 10 guidelines, M61
  • 42 should be used when there is clear documentation of calcification in the upper arm muscles
  • It is important to include any relevant imaging findings and the clinical context to support the diagnosis

Exclusion Criteria

Do NOT use M61.42 When
  • Exclusion criteria include conditions that are not specifically related to muscle calcification

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

Radiologic examination, shoulder

Clinical Scenario

Used when imaging is performed to assess calcification in the upper arm.

Documentation Requirements

Imaging reports must clearly indicate the presence of calcification.

Specialty Considerations

Orthopedic specialists should ensure imaging correlates with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of muscle calcification, improving the accuracy of diagnoses and treatment tracking. M61.42 provides a clear classification for this condition, facilitating better patient management and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of muscle calcification, improving the accuracy of diagnoses and treatment tracking. M61.42 provides a clear classification for this condition, facilitating better patient management and research.

Reimbursement & Billing Impact

reimbursement and to avoid audits.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of muscle calcification?

Common causes include trauma, metabolic disorders, inflammatory conditions like myositis, and idiopathic factors. Each case should be evaluated individually to determine the underlying cause.