2024 ICD-10-CM Diagnosis Code M80.8AXA
Other osteoporosis with current pathological fracture, other site, initial encounter for fracture
- ICD-10-CM Code:
- M80.8AXA
- ICD-10 Code for:
- Other osteopor with current path fracture, other site, init
- Is Billable?
- Yes - Valid for Submission
- Chronic Condition Indicator: [1]
- Chronic
- Code Navigator:
M80.8AXA is a billable diagnosis code used to specify a medical diagnosis of other osteoporosis with current pathological fracture, other site, initial encounter for fracture. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.
M80.8AXA is an initial encounter code, includes a 7th character and should be used while the patient is receiving active treatment for a condition like other osteoporosis with current pathological fracture other site for fracture. According to ICD-10-CM Guidelines an "initial encounter" doesn't necessarily means "initial visit". The 7th character should be used when the patient is undergoing active treatment regardless if new or different providers saw the patient over the course of a treatment. The appropriate 7th character codes should also be used even if the patient delayed seeking treatment for a condition.
The code is linked to some Quality Measures as part of Medicare's Quality Payment Program (QPP). When this code is used as part of a patient's medical record the following Quality Measures might apply: Osteoporosis Management In Women Who Had A Fracture.
Clinical Classification
| Clinical Category | CCSR Category Code | Inpatient Default CCSR | Outpatient Default CCSR |
|---|---|---|---|
| Osteoporosis | MUS013 | Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis. | Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis. |
| Pathological fracture, initial encounter | MUS014 | N - Not default inpatient assignment for principal diagnosis or first-listed diagnosis. | N - Not default outpatient assignment for principal diagnosis or first-listed diagnosis. |
Replacement Code
M808AXA replaces the following previously assigned ICD-10-CM code(s):
- M80.80XA - Oth osteopor w current path fracture, unsp site, init
Quality Payment Program Measures
When code M80.8AXA is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.
| Quality Measure | Description | Quality Domain | Measure Type | High Priority | Submission Methods |
|---|---|---|---|---|---|
| Osteoporosis Management in Women Who Had a Fracture | The percentage of women 50-85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the six months after the fracture. | Effective Clinical Care | Process | NO | Claims, Registry |
Code History
- FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
- FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
- FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
- FY 2021 - Code Added, effective from 10/1/2020 through 9/30/2021
Footnotes
[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:
- The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
- The condition places limitations on self-care, independent living, and social interactions.