M80.08XA: Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.08XA is a billable, specific ICD-10-CM code for age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture. It is valid for submission on a claim.
Check M80.08XA with the rest of the claim: free scrubber7th character "A": initial encounter for fracture
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 M80.08XA
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above M80.08XA
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with M80.08XA
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
M80.08XA risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 401 Vertebral Fractures without Spinal Cord Injury0.522 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
M80.08XA is named in 32 Medicare coverage policies: 25 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 M80.08
- M80.08XDAge-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing
- M80.08XGAge-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing
- M80.08XKAge-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion
- M80.08XPAge-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion
- M80.08XSAge-related osteoporosis with current pathological fracture, vertebra(e), sequela