2027 ICD-10-CM Diagnosis Code M80.022AAge-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture
ICD-10-CM Codes›M00–M99›M80-M85›M80
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- 7th Character A — Initial Encounter for Fracture
- Chronic Condition
M80.022A is a billable ICD-10-CM diagnosis code for age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture. The 7th character A means initial encounter for fracture, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 542 through 544, 791, 793. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 214 closely related codes. The code is restricted by the Medicare Code Editor to adult patients (age 15 through 124). Coders also document this condition as pathological fracture - upper arm. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Osteoporosis; and Pathological fracture, initial encounter.
M80.022A does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 87 for payment year 2027.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for M80.022A.
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when M80.022A is part of the patient record.
Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older
High Priority: YES
Measure Type: Process
Submission Methods: Claims, Registry
Description: Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient’s on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing. This measure is submitted by the physician who treats the fracture and who therefore is held accountable for the communication.
Osteoporosis Management in Women Who Had a Fracture
High Priority: NO
Measure Type: Process
Submission Methods: Claims, Registry
Description: 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 180 days after the fracture.
Medicare Risk Adjustment (HCC)Billing
M80.022A does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model, but it maps to payment categories in the other CMS models shown below.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Pathological fracture - upper arm
- Pathological fracture of left humerus
- Pathological fracture of left humerus due to osteoporosis
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M80.022A: its own notes plus those printed at M80 and Chapter 13. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- osteoporosis with current fragility fracture
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- personal history of (healed) osteoporosis fracture (Z87.310)
- arthropathic psoriasis (L40.5-)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- compartment syndrome (traumatic) (T79.A-)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
Notes
General instructions on how these codes are used.
- Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition
7th Character
Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.
- The appropriate 7th character is to be added to each code from category M80:
- Ainitial encounter for fracture this code
- Dsubsequent encounter for fracture with routine healing
- Gsubsequent encounter for fracture with delayed healing
- Ksubsequent encounter for fracture with nonunion
- Psubsequent encounter for fracture with malunion
- Ssequela
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name M80.022A, its category, or a range that includes it.
Excludes1 9
These codes carry an Excludes1 note naming M80.022A: they are not reported together with it, unless the two conditions are unrelated.
- E55 Vitamin D deficiencyosteoporosis (M80.-) names M80.-, which includes this code
- E83.3 Disorders of phosphorus metabolism and phosphatasesosteoporosis (M80.-) names M80.-, which includes this code
- M43 Other deforming dorsopathiesspinal curvature in osteoporosis (M80.-) names M80.-, which includes this code
- M48.4 Fatigue fracture of vertebrapathological fracture of vertebra due to osteoporosis (M80.-) names M80.-, which includes this code
- M48.5 Collapsed vertebra, not elsewhere classifiedpathological fracture of vertebra due to osteoporosis (M80.-) names M80.-, which includes this code
- M81 Osteoporosis without current pathological fractureosteoporosis with current pathological fracture (M80.-) names M80.-, which includes this code
- M84.3 Stress fracturepathological fracture due to osteoporosis (M80.-) names M80.-, which includes this code
- M84.4 Pathological fracture, not elsewhere classifiedpathological fracture in osteoporosis (M80.-) names M80.-, which includes this code
- M84.6 Pathological fracture in other diseasepathological fracture in osteoporosis (M80.-) names M80.-, which includes this code
Excludes2 2
These codes carry an Excludes2 note naming M80.022A: its condition is not part of those codes, and both may be reported when the patient has both.
- M96 Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classifieddisorders associated with osteoporosis (M80) names M80, which includes this code
- N95 Menopausal and other perimenopausal disorderspostmenopausal osteoporosis with current pathological fracture (M80.0-) names M80.0-, which includes this code
Code First 1
These codes say to code first a condition named in the note, and M80.022A is one of the conditions named.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
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 M80.022A to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M80.022AOverview
Is M80.022A a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character A in M80.022A mean?
The final character A marks the initial encounter: use it while the patient is receiving active treatment for age-related osteoporosis with current pathological fracture, left humerus, such as an emergency visit or first evaluation. In this category the CMS Tabular List defines A as "initial encounter for fracture".
What MS-DRG does M80.022A group to?
When age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture is the principal diagnosis on an inpatient stay, it groups to MS-DRG 543, 793, 791, 544, 542, with relative weights from 0.7404 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is M80.022A a CC or MCC?
CMS lists M80.022A as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 214 closely related codes in its exclusion list.
Who can M80.022A be reported for?
The Medicare Code Editor checks age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture against patient demographics: this code is intended for adult patients (age 15 through 124). Claims outside these limits are flagged as inconsistent.
Does M80.022A risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage: M80.022A maps to no category in the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 87 (Osteoporosis, Vertebral and Pathological Fractures).
