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ICD-10 Guide
ICD-10 CodesM61.511

M61.511

Billable

Other ossification of muscle, right shoulder

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

Code Description

ICD-10 M61.511 is a billable code used to indicate a diagnosis of other ossification of muscle, right shoulder.

Key Diagnostic Point:

M61.511 refers to a condition characterized by abnormal bone formation within the muscle tissue of the right shoulder. This ossification can occur due to various factors, including trauma, prolonged immobilization, or certain neuromuscular disorders. Clinically, patients may present with muscle stiffness, pain, and reduced range of motion in the affected shoulder. The condition can be associated with myositis, which is inflammation of the muscle, leading to muscle weakness and discomfort. In some cases, the ossification may be a result of myositis ossificans, where muscle tissue is replaced by bone following injury. Diagnosis typically involves imaging studies such as X-rays or MRI to visualize the ossified areas and differentiate them from other conditions. Treatment may include physical therapy, pain management, and in some cases, surgical intervention to remove the ossified tissue if it significantly impairs function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of muscle ossification
  • Need for precise documentation of symptoms and imaging results
  • Potential overlap with other musculoskeletal codes
  • Variability in treatment approaches and their documentation

Audit Risk Factors

  • Inadequate documentation of the clinical rationale for ossification
  • Failure to document associated symptoms or conditions
  • Misclassification of the type of muscle disorder
  • Lack of imaging results in the medical record

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with shoulder pain and limited range of motion due to ossification.

Billing Considerations

Ensure clear documentation of the relationship between trauma and ossification.

Rheumatology

Documentation Requirements

Comprehensive assessment of inflammatory markers and muscle strength testing.

Common Clinical Scenarios

Patients with myositis presenting with ossification as a complication.

Billing Considerations

Document any autoimmune conditions that may contribute to muscle ossification.

Coding Guidelines

Inclusion Criteria

Use M61.511 When
  • According to ICD
  • 10 coding guidelines, M61
  • 511 should be used when there is clear documentation of ossification in the right shoulder muscle
  • It is important to ensure that the condition is not a result of other specified conditions or injuries

Exclusion Criteria

Do NOT use M61.511 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 a patient with M61.511 requires aspiration of the shoulder joint due to swelling.

Documentation Requirements

Document the indication for the procedure and the findings during aspiration.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is linked to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like M61.511, improving the accuracy of patient records and facilitating better treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like M61.511, improving the accuracy of patient records and facilitating better treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like M61.511, improving the accuracy of patient records and facilitating better treatment planning.

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 is the primary cause of ossification in muscle?

Ossification in muscle can be caused by trauma, inflammation, or certain genetic conditions. It often occurs as a response to injury or chronic muscle inflammation.