M80.012S
M80.012S: Age-related osteoporosis with current pathological fracture, left shoulder, sequela
Billable / specific codeICD-10-CMPOA exemptleft
M80.012S is a billable, specific ICD-10-CM code for age-related osteoporosis with current pathological fracture, left shoulder, sequela. It is valid for submission on a claim.
Check M80.012S with the rest of the claim: free scrubber7th character "S": sequela
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 inherited from the categories above M80.012S
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above M80.012S
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with M80.012S
Their own Excludes1 notes name this code, so the conflict is not listed above.
- E55Vitamin D deficiency
- 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
- M84.6Pathological fracture in other disease
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
M80.012S is named in 19 Medicare coverage policies: 12 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under M80.012
- M80.012AAge-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture
- M80.012DAge-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing
- M80.012GAge-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing
- M80.012KAge-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion
- M80.012PAge-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion