ICD Code M61.111

ICD code M61.111 refers to Myositis ossificans progressiva affecting the right shoulder. This condition involves the abnormal development of bone tissue within muscle, leading to stiffness and restricted movement in the affected area. In this case, the right shoulder is impacted, which can significantly limit the range of motion and cause discomfort or pain. This code is used by healthcare providers to accurately document and communicate the diagnosis for billing and treatment purposes.

When to use the ICD code for Myositis ossificans progressiva, right shoulder:

1. Diagnosis Confirmation: The patient has been clinically diagnosed with myositis ossificans progressiva through a thorough medical evaluation.

2. Symptoms Present:

- Progressive pain and swelling in the affected shoulder.

- Limited range of motion in the right shoulder joint.

- Presence of hard lumps or masses in the soft tissue around the shoulder.

- History of trauma or injury to the shoulder area, although not always present.

3. Imaging Findings: Radiological evidence (e.g., X-rays, MRI) shows abnormal bone formation in the soft tissues of the right shoulder.

4. Exclusion of Other Conditions: Other potential causes of shoulder pain and ossification (e.g., fractures, infections, tumors) have been ruled out through differential diagnosis.

5. Family History: A documented family history of myositis ossificans progressiva or related conditions may support the diagnosis.

6. Progressive Nature: The condition is characterized by a progressive increase in symptoms and physical findings over time.

7. Age of Onset: Symptoms typically begin in early adulthood or childhood, aligning with the known age range for this condition.

8. Clinical Documentation: Comprehensive clinical documentation supports the diagnosis, including patient history, physical examination findings, and any relevant laboratory results.

Using the ICD code is appropriate when all of these diagnostic criteria and symptoms are met, ensuring accurate coding and billing for the condition.

For the ICD code M61.111, which pertains to myositis ossificans progressiva of the right 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 - Tenotomy, shoulder area; single tendon.

5. 24320 - Tenolysis, biceps tendon, shoulder area.

6. 24341 - Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff).

7. 24342 - Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft.

These CPT codes are examples of procedures that might be considered in the management of conditions related to myositis ossificans progressiva in the shoulder area. It is important for healthcare providers to select the appropriate CPT code based on the specific treatment plan and clinical scenario. Always ensure that the selected CPT codes align with the services provided and are supported by the patient's medical documentation.

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