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ICD-10 Guide
ICD-10 CodesM61.522

M61.522

Billable

Other ossification of muscle, left upper arm

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

Code Description

ICD-10 M61.522 is a billable code used to indicate a diagnosis of other ossification of muscle, left upper arm.

Key Diagnostic Point:

M61.522 refers to a condition characterized by abnormal bone formation within the muscle tissue of the left upper arm. This ossification can occur due to various factors, including trauma, prolonged immobilization, or certain myopathies. The presence of ossification can lead to muscle stiffness, pain, and functional impairment, as the affected muscle may lose its elasticity and strength. Clinically, patients may present with symptoms such as localized swelling, tenderness, and reduced range of motion in the shoulder and elbow joints. Diagnosis typically involves imaging studies, such as X-rays or MRI, to visualize the ossified areas and differentiate them from other conditions like myositis or tumors. Treatment may include physical therapy, pain management, and in some cases, surgical intervention to remove the ossified tissue if it significantly impacts function. Understanding the underlying causes and associated muscle disorders is crucial for effective management and rehabilitation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other muscle disorders like myositis.
  • Need for precise documentation of the location and extent of ossification.
  • Potential overlap with other ICD-10 codes related to muscle conditions.
  • Variability in clinical presentation and treatment approaches.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to specify laterality (left vs. right).
  • Lack of imaging reports to support the diagnosis.
  • Misclassification with other muscle disorders.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes, imaging results, and treatment plans.

Common Clinical Scenarios

Patients with post-traumatic ossification or chronic muscle conditions.

Billing Considerations

Ensure clear documentation of the functional impact of ossification.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, therapy notes, and progress reports.

Common Clinical Scenarios

Rehabilitation of patients post-surgery or with significant muscle stiffness.

Billing Considerations

Focus on documenting the patient's functional limitations and response to therapy.

Coding Guidelines

Inclusion Criteria

Use M61.522 When
  • According to ICD
  • 10 guidelines, M61
  • 522 should be used when there is clear documentation of ossification in the left upper arm muscle

Exclusion Criteria

Do NOT use M61.522 When
  • It is important to exclude other conditions that may mimic symptoms, such as myositis or tumors, and to document the specific muscle affected

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used when treating associated joint pain due to muscle ossification.

Documentation Requirements

Document the reason for the procedure and the findings.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between the procedure and 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 M61.522, improving the accuracy of diagnoses and treatment tracking. This specificity aids in better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like M61.522, improving the accuracy of diagnoses and treatment tracking. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

impact of the condition are essential for justifying the medical necessity of services rendered.

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 symptoms associated with M61.522?

Common symptoms include localized pain, stiffness, swelling in the left upper arm, and reduced range of motion in the shoulder and elbow joints.