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M80.812A vs M80.819A

M80.812A (Other osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture) compared with M80.819A (Other osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture), from the official CMS tabular data. M80.812A and M80.819A code the same condition on opposite sides.

Relationship

Review

Laterality relationship

M80.812A
Left
Other osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture
↔
M80.819A
Unspecified
Other osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture

Same condition; these differ only in which side is documented.

These codes share a category and title and differ only in the side affected. The documentation decides which applies, and a bilateral code is reported only where the code set provides one.

Source: ICD-10-CM tabular list (laterality variant derived from the code title)

Can these codes be reported together?

Same condition, opposite side. M80.812A and M80.819A name the same condition on opposite sides of the body.

Same category and title, differing only in which side is affected — the documentation decides which one applies, and a bilateral code is reported only where the code set provides one.

Side by side

M80.812AOther osteoporosis with current pathological fracture, left shoulder, initial encounter for fractureM80.819AOther osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture
Billing statusBillableBillable
ClassificationM00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
DefinitionOther osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture is a billable ICD-10-CM diagnosis code (M80.812A).Other osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture is a billable ICD-10-CM diagnosis code (M80.819A).
7th characterThe appropriate 7th character is to be added to each code from category M80:The appropriate 7th character is to be added to each code from category M80:
Includes
osteoporosis with current fragility fracture
osteoporosis with current fragility fracture
Use additional code
code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
code to identify major osseous defect, if applicable (M89.7-)
code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
code to identify major osseous defect, if applicable (M89.7-)
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Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources