M80: Osteoporosis with current pathological fracture
M80 is a non-billable header ICD-10-CM code for osteoporosis with current pathological fracture. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.
This code requires a 7th character
The appropriate 7th character is to be added to each code from category M80:
- 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
Excludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
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.
- personal history of (healed) osteoporosis fracture (Z87.310)
Use additional code
Add a secondary code to capture the detail described below.
- code to identify major osseous defect, if applicable (M89.7-)
Includes
Conditions this code covers.
- osteoporosis with current fragility fracture
Other codes that can never be billed with M80
Their own Excludes1 notes name this code, so the conflict is not listed above.
- E55Vitamin D deficiency
- K91.2Postsurgical malabsorption, not elsewhere classified
- M43Other deforming dorsopathies
- M48.4Fatigue fracture of vertebra
- M48.5Collapsed vertebra, not elsewhere classified
- M81Osteoporosis without current pathological fracture
- M84.3Stress fracture
- M84.4Pathological fracture, not elsewhere classified
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Code history
Unchanged in every release from FY2024 to FY2027.
Code to one of these instead M80
2 child codes. Green means billable.