Is M80.869S a billable ICD-10-CM code?

Yes. M80.869S is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does M80.869S 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).

What cannot be coded together with M80.869S?

M80.869S carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M80.869S (M80) and apply to it just the same.

M80.869S

M80.869S — Other osteoporosis with current pathological fracture, unspecified lower leg, sequela

Billable / specific codeICD-10-CMPOA exemptunspecified

M80.869S is a billable, specific ICD-10-CM code for other osteoporosis with current pathological fracture, unspecified lower leg, sequela. It is valid for submission on a claim.

7th 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 M80.869S

These are not written on M80.869S, but they bind it: a note on a category applies to every code beneath it. Billing M80.869S with anything listed here is a denial.

Written on M80 — Osteoporosis with current pathological fracture

collapsed vertebra NOS (M48.5)
pathological fracture NOS (M84.4)
wedging of vertebra NOS (M48.5)

Excludes2 inherited from the categories above M80.869S

Also inherited, and the opposite of Excludes1: these conditions are not part of M80.869S, but a patient can have both, so you may code both.

Written on M80 — Osteoporosis with current pathological fracture

personal history of (healed) osteoporosis fracture (Z87.310)

Other codes that can never be billed with M80.869S

These codes carry an Excludes1 note pointing at M80.869S. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M80.869S alone.

E55Vitamin D deficiency
E83.3Disorders of phosphorus metabolism and phosphatases
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

M80.869S 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.

Medicare coverage

M80.869S is named in 11 Medicare coverage policies — 4 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

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

M80.869S has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share M80.869. If M80.869S is not quite right, the correct code is usually one of these.

Questions about M80.869S

Is M80.869S a billable ICD-10-CM code?: Yes. M80.869S is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does M80.869S 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).
What cannot be coded together with M80.869S?: M80.869S carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M80.869S (M80) and apply to it just the same.