M80-M85 — Disorders of bone density and structure
ICD-10-CM codes M80-M85 cover disorders of bone density and structure, within diseases of the musculoskeletal system and connective tissue. The block holds 1,757 codes across 5 categories, of which 1,432 are billable and 325 are header codes that cannot be submitted on a claim. 1,480 of them (84%) require a 7th character.
The 7th character in M80-M85
A code in this block is not complete without its 7th character, and a missing one is a rejected claim rather than a denied one: the clearinghouse never passes it on. 1,480 of the 1,757 codes here take one.
- A
- initial encounter for fracture
- D
- subsequent encounter for fracture with routine healing
- G
- subsequent encounter for fracture with delayed healing
- K
- subsequent encounter for fracture with nonunion
- P
- subsequent encounter for fracture with malunion
- S
- sequela
Risk adjustment in M80-M85
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 402 Hip Fracture/Dislocation
- HCC 401 Vertebral Fractures without Spinal Cord Injury
What else to watch in M80-M85
- 998 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
- 1,432 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.