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M80 ICD-10-CM Code: Osteoporosis with current pathological fracture

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Coding at a Glance

7th character
Required — characters A · D · G · K · P · S
Tabular directives
1 inclusion term · 3 Excludes1 · 1 Excludes2 · 1 use-additional code

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for M80 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • osteoporosis with current fragility fracture

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify major osseous defect, if applicable (M89.7-)

7th Character Guide

"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

How the encounter character is assigned. “Initial encounter” means the patient is receiving active treatment for the condition — it is not limited to the first visit, and a different or new provider giving active treatment still assigns it. “Subsequent encounter” covers care during the healing or recovery phase after active treatment. “Sequela” is for complications or conditions that arise as a direct result of the original condition.

ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.a (paraphrased by MedCoder).

Variant codes in this family

M80-M85, M80-M94, M80.00XA, M80.00XD, M80.00XG, M80.00XK, M80.00XP, M80.00XS

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for M80

MedCoder structured workflow — derived from this code’s own official record

Before you code M80

  1. M80 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewM80.0, M80.8

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. A 7th character is required in this family. Confirm the documented encounter: initial (active treatment), subsequent (healing or recovery phase), or sequela. M80 is not valid without one. “Initial” means active treatment, not the first visit (Guidelines I.C.19.a).

    See the 7th Character Guide · Guide: 7th characters: initial, subsequent, sequela →

  3. M80’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  4. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with M80. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support one of the more specific codes beneath M80?
    Yes → Select that code and continue the checks below on its own page.
    No → M80 cannot be reported as written; query for the specificity its subcategory needs.

    ReviewM80.0, M80.8

  2. Does the documentation support a condition named in M80’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewM48.5, M84.4

  3. Is the encounter phase documented — active treatment, healing or recovery, or a sequela?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Consider M80. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Encounter type
Active treatment, healing or recovery phase, or sequela — the basis of the 7th character (Guidelines I.C.19.a).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
Open or closed; displaced or nondisplaced
Defaults apply when the record is silent: closed, and displaced (Guidelines I.C.19.c).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes1 — check before selecting M80(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with M80: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareM48.5, M84.4

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of M80(1 note)

    Coding workflow: The conditions named in this note are not included in M80. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareZ87.310

    See the official tabular notes · Guidelines I.A.12.b

  • Use Additional Code — after identifying M80(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with M80 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewM89.7

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition M80 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewM48.5, M84.4

Documentation: The patient returns during the healing or recovery phase after active treatment of the same condition.

Coding question: Which 7th character applies?

Path: Review the official 7th-character definitions for this family in the 7th Character Guide.

Reason: “Initial encounter” means active treatment, not the first visit; care during recovery takes “subsequent encounter”, and a complication arising from the original condition takes “sequela” (Guidelines I.C.19.a).

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is M80 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Osteoporosis with current pathological fracture is a non-billable ICD-10-CM category code (M80). A more specific billable subcode must be selected for claims submission.

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)

1) Bone versus joint For certain conditions, the bone may be affected at the upper or lower end, (e.g., avascular necrosis of bone, M87, Osteoporosis, M80, M81).

Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)

d. Osteoporosis Osteoporosis is a systemic condition, meaning that all bones of the musculoskeletal system are affected. Therefore, site is not a component of the codes under category M81, Osteoporosis without current pathological fracture. The site codes under category M80, Osteoporosis with current pathological fracture, identify the site of the fracture, not the osteoporosis.

Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)

2) Osteoporosis with current pathological fracture Category M80, Osteoporosis with current pathological fracture, is for patients who have a current pathologic fracture at the time of an encounter. The codes under M80 identify the site of the fracture. A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.

Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)

A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  3. 3 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  4. 1 Excludes2 entry — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name M80 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 10 Excludes1 notes across 3 chapters: E55 — Vitamin D deficiency, E83.3 — Disorders of phosphorus metabolism and phosphatases, M43 — Other deforming dorsopathies, M48.4 — Fatigue fracture of vertebra, M48.5 — Collapsed vertebra, not elsewhere classified, M81 — Osteoporosis without current pathological fracture, M84.3 — Stress fracture, M84.4 — Pathological fracture, not elsewhere classified, M84.6 — Pathological fracture in other disease, R29.890 — Loss of height.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: M96 — Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code First instruction: M89.7 — Major osseous defect.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Referenced by 1 Code Also instruction: Z91.B — Personal risk factor of exposure to diethylstilbestrol.

These codes suggest coding this condition alongside when both are present.

Contextual Map

Every relationship of M80 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run M80 with these 12 related codes in Claim Check

Hierarchy

Excludes1

Excludes2

Use Additional Code

  • M89.7 — Major osseous defect[Use Additional Code]: “code to identify major osseous defect, if applicable (M89.7-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes1 notes (10)

Referenced by Excludes2 notes

Referenced by Code First instructions

Referenced by Code Also instructions

Nearest codes (396)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Common coding questions

Can M80 be billed directly?

No. M80 (Osteoporosis with current pathological fracture) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does M80 require a 7th character?

Yes. 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.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "M80 — Osteoporosis with current pathological fracture." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/m80-osteoporosis-with-current-pathological-fracture

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Osteoporosis with current pathological fracture

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M80 in its code family, with their registry titles.