M81.6 ICD-10-CM Code: Localized osteoporosis [Lequesne]

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for M81.6 in the official ICD-10-CM tabular list, quoted as published.

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

Notes without a marker are published on M81.6 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for M81.6

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

Before you code M81.6

1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with M81.6. 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 a condition named in M81.6’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.

   ReviewM89.0, M80

Consider M81.6. 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).

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).

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 M81.6(2 notes)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with M81.6: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareM89.0, M80

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

• Use Additional Code — after identifying M81.6(3 notes)

  Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with M81.6 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

  ReviewM89.7, Z87.310

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

Coding decision scenarios

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

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.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Osteoporosis (female) (male), Lequesne
• Osteoporosis (female) (male), localized

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.

Don’t confuse M81.6 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of M81.6 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• M89.0— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of Sudeck's atrophy moves the case to M89.0; the two are not reported together unless documented as unrelated.

  Full comparison: M81.6 vs M89.0 →

• M80— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of osteoporosis with current pathological fracture moves the case to M80; the two are not reported together unless documented as unrelated.

  Full comparison: M81.6 vs M80 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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 M81.6 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 1 Excludes1 note: R29.890 — Loss of height (via M81.-).

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

Referenced by 1 Code First instruction: M89.7 — Major osseous defect (via M81.-).

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.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 553 (MDC 08), DRG 554 (MDC 08).

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).

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 category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Osteoporosis).

M80.839A — Other osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture, M80.841A — Other osteoporosis with current pathological fracture, right hand, initial encounter for fracture, M80.842A — Other osteoporosis with current pathological fracture, left hand, initial encounter for fracture, M80.849A — Other osteoporosis with current pathological fracture, unspecified hand, 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, M80.861A — Other osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture, M80.862A — Other osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture, M80.869A — Other osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture, M80.871A — Other osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture, M80.872A — Other osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture, M80.879A — Other osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture, M80.88XA — Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture, M80.8AXA — Other osteoporosis with current pathological fracture, other site, initial encounter for fracture, M80.8B1A — Other osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture, M80.8B2A — Other osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture, M80.8B9A — Other osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture, M81.0 — Age-related osteoporosis without current pathological fracture, M81.8 — Other osteoporosis without current pathological fracture, +36 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.

M80.02 — Age-related osteoporosis with current pathological fracture, humerus (postmenopausal, with pathological fracture, humerus), M80.03 — Age-related osteoporosis with current pathological fracture, forearm (postmenopausal, with pathological fracture, ulna), M80.04 — Age-related osteoporosis with current pathological fracture, hand (postmenopausal, with pathological fracture, finger), M80.05 — Age-related osteoporosis with current pathological fracture, femur (postmenopausal, with pathological fracture, hip), M80.06 — Age-related osteoporosis with current pathological fracture, lower leg (postmenopausal, with pathological fracture, tibia), M80.07 — Age-related osteoporosis with current pathological fracture, ankle and foot (postmenopausal, with pathological fracture, toe), M80.08 — Age-related osteoporosis with current pathological fracture, vertebra(e) (postmenopausal, with pathological fracture, vertebra), M80.0A — Age-related osteoporosis with current pathological fracture, other site (postmenopausal, with pathological fracture, ilium), M80.0B — Age-related osteoporosis with current pathological fracture, pelvis (postmenopausal, with pathological fracture, pelvis), M80.80 — Other osteoporosis with current pathological fracture, unspecified site (disuse, with current pathological fracture), M80.81 — Other osteoporosis with pathological fracture, shoulder (disuse, with current pathological fracture, scapula), M80.82 — Other osteoporosis with current pathological fracture, humerus (disuse, with current pathological fracture, humerus), M80.83 — Other osteoporosis with current pathological fracture, forearm (disuse, with current pathological fracture, ulna), M80.84 — Other osteoporosis with current pathological fracture, hand (disuse, with current pathological fracture, finger), M80.85 — Other osteoporosis with current pathological fracture, femur (disuse, with current pathological fracture, hip), M80.86 — Other osteoporosis with current pathological fracture, lower leg (disuse, with current pathological fracture, tibia), M80.87 — Other osteoporosis with current pathological fracture, ankle and foot (disuse, with current pathological fracture, toe), M80.88 — Other osteoporosis with current pathological fracture, vertebra(e) (disuse, with current pathological fracture, vertebra), M80.8A — Other osteoporosis with current pathological fracture, other site (disuse, with current pathological fracture, site specified NEC), M80.8B — Other osteoporosis with current pathological fracture, pelvis (disuse, with current pathological fracture, ilium), +2 more

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.

Thyroid Stimulating Hormone (TSH)

Contextual Map

Every relationship of M81.6 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 M81.6 with these 2 related codes in Claim Check

Hierarchy

• M00-M99 — Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) (M00-M99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M80-M85 — Disorders of bone density and structure[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• R29.890 — Loss of height[Excludes1](via M81.-): “osteoporosis (M80-M81)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Code First instructions

• M89.7 — Major osseous defect[Code First](via M81.-): “osteoporosis (M80.-, M81.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• MUS013 — Osteoporosis[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 553 — BONE DISEASES AND ARTHROPATHIES WITH MCC[MS-DRG]: “BONE DISEASES AND ARTHROPATHIES WITH MCC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 554 — BONE DISEASES AND ARTHROPATHIES WITHOUT MCC[MS-DRG]: “BONE DISEASES AND ARTHROPATHIES WITHOUT MCC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 08 — Diseases and Disorders of the Musculoskeletal System and Connective Tissue[MDC crossing]: “Diseases and Disorders of the Musculoskeletal System and Connective Tissue — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 18,508 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Osteoporosis (female) (male), Lequesne[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Osteoporosis (female) (male), localized[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

• M81 — Osteoporosis without current pathological fracture[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M81.0 — Age-related osteoporosis without current pathological fracture[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M81.8 — Other osteoporosis without current pathological fracture[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Change history

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

Relevant guides

• Traumatic, Pathological, or Stress Fracture: Which Family, and the Osteoporosis Rule →

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

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M81.6 in its code family, with their registry titles.

• M81 — Osteoporosis without current pathological fracture
• M81.0 — Age-related osteoporosis without current pathological fracture
• M81.8 — Other osteoporosis without current pathological fracture

View all codes in the M81 family