Cracking the Code

Coding Osteoporosis

As per the Mayo Clinic, “Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over, or coughing can cause a break. Osteoporosis-related breaks most commonly occur in the hip, wrist or spine. Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone. Osteoporosis affects men and women of all races.”

Osteoporosis is coded based on the type, such as age-related or other, and with or without current pathologic fracture. The site is not required to code osteoporosis when there is no current pathological fracture. It is important to note that when a current pathological fracture occurs with osteoporosis, the site must be known to determine the correct code and one combination code is reported for the pathological fracture and osteoporosis.

For category M80 Osteoporosis with current pathological fracture, you are instructed to use an additional code to identify major osseous defect, if applicable (M89.7-). 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.

For category M81 Osteoporosis without current pathological fracture, a history code should also be reported if the patient has had a fracture in the past.

Q: A patient with age-related osteoporosis suffers a pathologic fracture to his right hip. He is being seen for this new fracture today. What is the appropriate ICD-10-CM code for this encounter?
A: M80.051A. Rationale: A combination code is reported for the pathological fracture and osteoporosis. We are going to look in the ICD-10-CM Alphabetic Index, under Osteoporosis/age related/with current pathological fracture/hip M80.05-. When we follow the code in the Tabular List, we see that this section includes osteoporosis with current pathological fracture and the subcategory code is reported for age-related osteoporosis with current pathological fracture of femur, which includes the hip. Additionally, a 6th character is required. We will complete the code with the 6th character of “1” for right femur and a 7th character of “A” for initial encounter to complete the code.
Reference: 2024 ICD-10-CM code book
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