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 an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

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.-)

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 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 an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.