Is M80.819 a billable ICD-10-CM code?

No. M80.819 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M80.819 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Disorders of bone density and structure (M80-M85).

M80.819

M80.819 — Other osteoporosis with current pathological fracture, unspecified shoulder

Non-billable headerICD-10-CMunspecified

M80.819 is a non-billable header ICD-10-CM code for other osteoporosis with current pathological fracture, unspecified shoulder. 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

Risk adjustment

M80.819 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 M80.819

6 child codes. Green means billable.

Related codes at this level

Codes that share M80.81. If M80.819 is not quite right, the correct code is usually one of these.

Questions about M80.819

Is M80.819 a billable ICD-10-CM code?: No. M80.819 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M80.819 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Disorders of bone density and structure (M80-M85).