M80.88XA — Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.88XA is a billable, specific ICD-10-CM code for other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture. It is valid for submission on a claim.
7th 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 M80.88XA
These are not written on M80.88XA, but they bind it: a note on a category applies to every code beneath it. Billing M80.88XA with anything listed here is a denial.
Excludes2 inherited from the categories above M80.88XA
Also inherited, and the opposite of Excludes1: these conditions are not part of M80.88XA, but a patient can have both, so you may code both.
Other codes that can never be billed with M80.88XA
These codes carry an Excludes1 note pointing at M80.88XA. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M80.88XA 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
M80.88XA 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.
Medicare coverage
M80.88XA is named in 35 Medicare coverage policies — 28 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
M80.88XA 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 M80.88. If M80.88XA is not quite right, the correct code is usually one of these.
- M80.88XDOther osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing
- M80.88XGOther osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing
- M80.88XKOther osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion
- M80.88XPOther osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion
- M80.88XSOther osteoporosis with current pathological fracture, vertebra(e), sequela
Questions about M80.88XA
- Is M80.88XA a billable ICD-10-CM code?
- Yes. M80.88XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M80.88XA 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 M80.88XA?
- M80.88XA 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 M80.88XA (M80) and apply to it just the same.