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M80.051A ICD-10-CM Code: Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
1 inclusion term · 3 Excludes1 · 1 Excludes2 · 1 use-additional code
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 170 · RxHCC V08 category 87

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 521 — HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC (MDC 08)
  • MS-DRG 522 — HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC (MDC 08)
  • MS-DRG 542 — PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC (MDC 08)
  • MS-DRG 543 — PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC (MDC 08)
  • MS-DRG 544 — PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC (MDC 08)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 402 — Hip Fracture/Dislocation

Other models: CMS-HCC V22 HCC 170 · RxHCC V08 HCC 87

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Code Overview

Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture is a billable ICD-10-CM diagnosis code (M80.051A).

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

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for M80.051A in the official ICD-10-CM tabular list.

Notes without a marker are published on M80.051A itself; “inherited from” names the category or block whose note applies here.

Includes

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

  • osteoporosis with current fragility fracture

Source: inherited from M80

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).

Source: inherited from M80

Excludes2 — Not Included Here

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

Source: inherited from M80

Use Additional Code

Supplementary codes the tabular list directs you to add.

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

Source: inherited from M80

7th Character Guide

"The appropriate 7th character is to be added to each code from category M80:"

  • A — initial encounter for fracture (this page’s code)
  • 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

M80.051A, M80.051D, M80.051G, M80.051K, M80.051P, M80.051S

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.

Official Coding 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.

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Age-related osteoporosis with current pathological fracture, right femur, initial encounter for 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.

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. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
  3. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  4. 3 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  5. 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

  • Age-restricted: the Medicare Code Editor lists this as an adult (age 15-124) diagnosis; other ages are presumed incorrect.
  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

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

Other codes that name M80.051A 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 (via M80.-), E83.3 — Disorders of phosphorus metabolism and phosphatases (via M80.-), M43 — Other deforming dorsopathies (via M80.-), M48.4 — Fatigue fracture of vertebra (via M80.-), M48.5 — Collapsed vertebra, not elsewhere classified (via M80.-), M81 — Osteoporosis without current pathological fracture (via M80.-), M84.3 — Stress fracture (via M80.-), M84.4 — Pathological fracture, not elsewhere classified (via M80.-), M84.6 — Pathological fracture in other disease (via M80.-), R29.890 — Loss of height (via M80.-).

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: N95 — Menopausal and other perimenopausal disorders (via M80.0.-).

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 (via M80.-).

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 (via M80.-).

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

MS-DRG Grouper Relationships (FY2026)

CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 214 clinically related codes on its CMS exclusion list.

Potential MS-DRG participation — not a DRG assignment.

Named in the grouper logic of 7 MS-DRGs: DRG 521 (MDC 08), DRG 522 (MDC 08), DRG 542 (MDC 08), DRG 543 (MDC 08), DRG 544 (MDC 08), DRG 791 (MDC 15), DRG 793 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MUS013 — Osteoporosis (default); MUS014 — Pathological fracture, initial encounter.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

M80.019A — Age-related osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture, M80.021A — Age-related osteoporosis with current pathological fracture, right humerus, initial encounter for fracture, M80.022A — Age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture, M80.029A — Age-related osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture, M80.031A — Age-related osteoporosis with current pathological fracture, right forearm, initial encounter for fracture, M80.032A — Age-related osteoporosis with current pathological fracture, left forearm, initial encounter for fracture, M80.039A — Age-related osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture, M80.041A — Age-related osteoporosis with current pathological fracture, right hand, initial encounter for fracture, M80.042A — Age-related osteoporosis with current pathological fracture, left hand, initial encounter for fracture, M80.049A — Age-related osteoporosis with current pathological fracture, unspecified hand, initial encounter for fracture, M80.052A — Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture, M80.059A — Age-related osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture, M80.061A — Age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture, M80.062A — Age-related osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture, M80.069A — Age-related osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture, M80.071A — Age-related osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture, M80.072A — Age-related osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture, M80.079A — Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture, M80.08XA — Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture, M80.80XA — Other osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture, +193 more

Same condition, opposite side

Same category and title, differing only in which side of the body is affected.

M80.052A — Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture (left)Compare M80.051A vs M80.052A →, M80.059A — Age-related osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture (unspecified)Compare M80.051A vs M80.059A →

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Hip Fracture/Dislocation) for risk-adjusted payment.

M80.052A — Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture, M80.059A — Age-related osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture, M80.851A — Other osteoporosis with current pathological fracture, right femur, initial encounter for fracture, M80.852A — Other osteoporosis with current pathological fracture, left femur, initial encounter for fracture, M80.859A — Other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture, M84.451A — Pathological fracture, right femur, initial encounter for fracture, M84.452A — Pathological fracture, left femur, initial encounter for fracture, M84.453A — Pathological fracture, unspecified femur, initial encounter for fracture, M84.459A — Pathological fracture, hip, unspecified, initial encounter for fracture, M84.551A — Pathological fracture in neoplastic disease, right femur, initial encounter for fracture, M84.552A — Pathological fracture in neoplastic disease, left femur, initial encounter for fracture, M84.553A — Pathological fracture in neoplastic disease, unspecified femur, initial encounter for fracture, M84.559A — Pathological fracture in neoplastic disease, hip, unspecified, initial encounter for fracture, M84.651A — Pathological fracture in other disease, right femur, initial encounter for fracture, M84.652A — Pathological fracture in other disease, left femur, initial encounter for fracture, M84.653A — Pathological fracture in other disease, unspecified femur, initial encounter for fracture, M84.659A — Pathological fracture in other disease, hip, unspecified, initial encounter for fracture, M84.754A — Complete transverse atypical femoral fracture, right leg, initial encounter for fracture, M84.755A — Complete transverse atypical femoral fracture, left leg, initial encounter for fracture, M84.756A — Complete transverse atypical femoral fracture, unspecified leg, initial encounter for fracture, +708 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Osteoporosis, Pathological fracture, initial encounter).

M80.019A — Age-related osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture, M80.021A — Age-related osteoporosis with current pathological fracture, right humerus, initial encounter for fracture, M80.022A — Age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture, M80.029A — Age-related osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture, M80.031A — Age-related osteoporosis with current pathological fracture, right forearm, initial encounter for fracture, M80.032A — Age-related osteoporosis with current pathological fracture, left forearm, initial encounter for fracture, M80.039A — Age-related osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture, M80.041A — Age-related osteoporosis with current pathological fracture, right hand, initial encounter for fracture, M80.042A — Age-related osteoporosis with current pathological fracture, left hand, initial encounter for fracture, M80.049A — Age-related osteoporosis with current pathological fracture, unspecified hand, initial encounter for fracture, M80.052A — Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture, M80.059A — Age-related osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture, M80.061A — Age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture, M80.062A — Age-related osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture, M80.069A — Age-related osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture, M80.071A — Age-related osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture, M80.072A — Age-related osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture, M80.079A — Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture, M80.08XA — Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture, M80.0AXA — Age-related osteoporosis with current pathological fracture, other site, initial encounter for fracture, +138 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Osteoporosis”; these codes share that main term but sit in a different category of the Tabular List.

M81.0 — Age-related osteoporosis without current pathological fracture, M81.6 — Localized osteoporosis [Lequesne] (Lequesne), M81.8 — Other osteoporosis without current pathological fracture (disuse)

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Partial Thromboplastin Time (PTT) Test

Contextual Map

Every relationship of M80.051A 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.

Hierarchy

Referenced by Excludes1 notes (10)

Referenced by Excludes2 notes

Referenced by Code First instructions

Referenced by Code Also instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 402 — Hip Fracture/Dislocation [CMS-HCC]

MS-DRG Grouper

MDC crossing

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]

Frequently Asked Questions (FAQ) & Clinical Guidance

Does M80.051A require a 7th character?

Yes. The appropriate 7th character is to be added to each code from category M80:.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M80.051A in its code family, with their registry titles.

View all codes in the M80 family