Is M62.1 a billable ICD-10-CM code?

No. M62.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M62.1 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Disorders of muscles (M60-M63).

What cannot be coded together with M62.1?

M62.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M62.1 (M62) and apply to it just the same.

M62.1

M62.1 — Other rupture of muscle (nontraumatic)

Non-billable headerICD-10-CM

M62.1 is a non-billable header ICD-10-CM code for other rupture of muscle (nontraumatic). It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

traumatic rupture of muscle - see strain of muscle by body region

Excludes2 — not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

rupture of tendon (M66.-)

Excludes1 inherited from the categories above M62.1

These are not written on M62.1, but they bind it: a note on a category applies to every code beneath it. Billing M62.1 with anything listed here is a denial.

Written on M62 — Other disorders of muscle

alcoholic myopathy (G72.1)
cramp and spasm (R25.2)
drug-induced myopathy (G72.0)
myalgia (M79.1-)
stiff-man syndrome (G25.82)

Excludes2 inherited from the categories above M62.1

Also inherited, and the opposite of Excludes1: these conditions are not part of M62.1, but a patient can have both, so you may code both.

Written on M62 — Other disorders of muscle

nontraumatic hematoma of muscle (M79.81)

Risk adjustment

M62.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code history

M62.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead M62.1

9 child codes. Green means billable.

Related codes at this level

Codes that share M62. If M62.1 is not quite right, the correct code is usually one of these.

Questions about M62.1

Is M62.1 a billable ICD-10-CM code?: No. M62.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M62.1 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Disorders of muscles (M60-M63).
What cannot be coded together with M62.1?: M62.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M62.1 (M62) and apply to it just the same.