2026 ICD-10-CM Diagnosis Code M80.021DAge-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing

ICD-10-CM Codes›M00–M99›M80-M85›M80

ICD-10-CM M80.021D
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

M80.021D is a billable ICD-10-CM diagnosis code for age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing. The 7th character D marks it as a subsequent encounter code, used during routine care in the healing or recovery phase. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 559 through 561. The code is restricted by the Medicare Code Editor to adult patients (age 15 through 124) and exempt from POA reporting. Coders also document this condition as pathological fracture - upper arm. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pathological fracture, subsequent encounter.

Code Identity

ICD-10-CM Code
M80.021D
Billable Status
Yes — Valid for Submission
Code Describes
Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing
Short Description
Age-rel osteopor w crnt path fx, r humer, 7thD
Parent Code
M80.021
Age-related osteoporosis with current pathological fracture, right humerus

Code Classification

ChapterM00–M99Diseases of the musculoskeletal system and connective tissue
SectionM80-M85Disorders of bone density and structure
CategoryM80Osteoporosis with current pathological fracture
This CodeM80.021DAge-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing

Code EditsBilling

Medicare Code Editor checks that affect claim validity for M80.021D.

Adult diagnoses
The Medicare Code Editor detects inconsistencies in adult cases by checking a patient's age and any diagnosis on the patient's record. The adult code edits apply to patients age range is 15–124 years inclusive (e.g., senile delirium, mature cataract).

Present on Admission (POA)Billing

M80.021D is exempt from POA reporting on inpatient claims to general acute care hospitals. Review other POA exempt codes.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Pathological fracture - upper arm
  • Pathological fracture of right humerus
  • Pathological fracture of right humerus due to osteoporosis

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR MUS015
Pathological fracture, subsequent encounter
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Arm Injuries and Disorders

Of the 206 bones in your body, three of them are in your arm: the humerus, radius, and ulna. Your arms are also made up of muscles, joints, tendons, and other connective tissue. Injuries to any of these parts of the arm can occur during sports, a fall, or an accident.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert M80.021D to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
V54.21 Aftercare path fx up arm
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About M80.021DOverview

Is M80.021D a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What does the 7th character D in M80.021D mean?

The final character D marks a subsequent encounter: use it for routine care while the age-related osteoporosis with current pathological fracture, right humerus is healing, after active treatment has ended.

What MS-DRG does M80.021D group to?

When age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing is the principal diagnosis on an inpatient stay, it groups to MS-DRG 559, 560, 561, with relative weights from 0.8039 to 1.8649 depending on complications. Higher weights mean higher Medicare reimbursement.

Who can M80.021D be reported for?

The Medicare Code Editor checks age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing against patient demographics: this code is intended for adult patients (age 15 through 124). Claims outside these limits are flagged as inconsistent.

Is M80.021D exempt from POA reporting?

Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing on inpatient claims.

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.