ICD Code M61.019

ICD code M61019 is used to classify a condition known as myositis ossificans traumatica affecting an unspecified shoulder. This condition involves the abnormal formation of bone tissue within the muscle, typically as a result of trauma or injury. The term "unspecified shoulder" indicates that the documentation does not specify whether the condition affects the left or right shoulder. This code is essential for healthcare providers to accurately document and communicate the diagnosis for billing, treatment planning, and statistical purposes.

When to use the ICD code M61019 for myositis ossificans traumatica, unspecified shoulder, consider the following diagnostic criteria and symptoms:

1. History of Trauma: Documented history of trauma or injury to the shoulder area, which may include fractures, dislocations, or significant soft tissue injury.

2. Pain in the Shoulder: Patient reports localized pain in the shoulder, which may be persistent or exacerbated by movement.

3. Swelling and Tenderness: Physical examination reveals swelling and tenderness in the shoulder region, indicating inflammation.

4. Limited Range of Motion: Assessment shows a reduced range of motion in the shoulder joint, potentially affecting daily activities.

5. Radiological Evidence: Imaging studies (such as X-rays or MRI) demonstrate the presence of calcification or ossification in the soft tissues surrounding the shoulder joint.

6. Exclusion of Other Conditions: Other potential causes of shoulder pain and ossification, such as infections, tumors, or other inflammatory conditions, have been ruled out through appropriate diagnostic testing.

7. Chronic Symptoms: Symptoms have persisted for a duration that suggests a chronic condition, typically beyond the acute phase of injury.

8. Response to Treatment: Lack of improvement or resolution of symptoms despite conservative treatment measures, such as physical therapy or anti-inflammatory medications.

By adhering to these criteria, healthcare providers can accurately determine the necessity of using the ICD code M61019 in their documentation and billing processes.

For the ICD code M61.019, which pertains to myositis ossificans traumatica of an unspecified shoulder, the relevant CPT codes that may be applicable for treatment include:

1. 20550 - Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia").

2. 20610 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa); without ultrasound guidance.

3. 24300 - Manipulation, shoulder joint, under anesthesia.

4. 24310 - Injection procedure for shoulder arthrography.

5. 24320 - Removal of foreign body, shoulder; subcutaneous.

6. 24330 - Removal of foreign body, shoulder; deep.

These CPT codes are examples of procedures that might be considered in the treatment plan for a patient with myositis ossificans traumatica of the shoulder. It is important for healthcare providers to select the most appropriate CPT code based on the specific treatment rendered and the clinical scenario. Always ensure that coding is compliant with the latest coding guidelines and payer-specific requirements.

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