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ICD-10 Guide
ICD-10 CodesM61.152

M61.152

Billable

Myositis ossificans progressiva, left thigh

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

Code Description

ICD-10 M61.152 is a billable code used to indicate a diagnosis of myositis ossificans progressiva, left thigh.

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 typically presents with progressive muscle stiffness and weakness, often following trauma or injury, although it can occur spontaneously. In the case of M61.152, the ossification is specifically localized to the left thigh. Patients may experience significant pain and reduced mobility due to the formation of heterotopic bone, which impairs normal muscle function. The condition is caused by mutations in the ACVR1 gene, which plays a crucial role in bone and muscle development. Diagnosis is primarily clinical, supported by imaging studies that reveal calcification in soft tissues. Management focuses on symptomatic relief and physical therapy, as surgical intervention is often complicated by the risk of further ossification. Understanding the nuances of this condition is essential for accurate coding and appropriate 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 the affected site (left thigh).
  • Differentiation from other myositis conditions and ossification disorders.
  • Potential for misdiagnosis or confusion with similar codes.

Audit Risk Factors

  • Inadequate documentation of the specific site of ossification.
  • Failure to document the genetic basis of the condition.
  • Misclassification of the condition as a more common myositis type.
  • Lack of supporting imaging studies in the medical record.

Specialty Focus

Medical Specialties

Rheumatology

Documentation Requirements

Detailed clinical notes including symptom onset, progression, and response to treatment.

Common Clinical Scenarios

Patients presenting with muscle stiffness and pain following trauma.

Billing Considerations

Documentation of family history and genetic testing results is crucial.

Orthopedics

Documentation Requirements

Imaging studies showing ossification and detailed surgical notes if applicable.

Common Clinical Scenarios

Patients requiring surgical intervention for bone removal.

Billing Considerations

Careful documentation of surgical risks related to the condition.

Coding Guidelines

Inclusion Criteria

Use M61.152 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the condition's specifics, including laterality and any associated symptoms

Exclusion Criteria

Do NOT use M61.152 When
  • Exclude conditions that do not meet the criteria for myositis ossificans progressiva

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

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

Clinical Scenario

Used when joint pain is present due to ossification.

Documentation Requirements

Document the reason for the procedure and any imaging findings.

Specialty Considerations

Orthopedic specialists should ensure clarity in the procedure notes.

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 the accuracy of patient records and facilitating better research and treatment options.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving the accuracy of patient records and facilitating better research and treatment options.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of rare conditions like myositis ossificans progressiva, improving the accuracy of patient records and facilitating better research and treatment options.

Resources

Clinical References

  • •
    Myositis ossificans progressiva overview

Coding & Billing References

  • •
    Myositis ossificans progressiva overview

Frequently Asked Questions

What is myositis ossificans progressiva?

Myositis ossificans progressiva is a rare genetic disorder that leads to the abnormal formation of bone in muscles and connective tissues, often resulting in pain and stiffness.