2026 ICD-10-CM Diagnosis Code M80.061AAge-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture
ICD-10-CM Codes›M00–M99›M80-M85›M80
- Billable — Valid for Submission
- 7th Character A — Initial Encounter
- Chronic Condition
M80.061A is a billable ICD-10-CM diagnosis code for age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 542 through 544. The code is restricted by the Medicare Code Editor to adult patients (age 15 through 124). Coders also document this condition as pathological fracture of fibula. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Osteoporosis; and Pathological fracture, initial encounter.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for M80.061A.
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when M80.061A 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 six months after the fracture.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Pathological fracture of fibula
- Pathological fracture of right fibula
- Pathological fracture of right fibula due to osteoporosis
- Pathological fracture of right tibia
- Pathological fracture of right tibia due to osteoporosis
- Pathological fracture of tibia
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Fractures
A fracture is a break in a bone. Fractures are usually caused by injuries. Since they can sometimes be serious, it's important to get medical care right away if you think you have a fracture.
The full article covers:
- What is a fracture?
- What are the different types of fractures?
- What causes fractures?
- What are the symptoms of a fracture?
- How are fractures diagnosed?
- What are the treatments for fractures?
- Can fractures be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert M80.061A to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M80.061AOverview
Is M80.061A a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character A in M80.061A 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, right lower leg, such as an emergency visit or first evaluation.
What MS-DRG does M80.061A group to?
When age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture is the principal diagnosis on an inpatient stay, it groups to MS-DRG 542, 543, 544, with relative weights from 0.7546 to 1.7665 depending on complications. Higher weights mean higher Medicare reimbursement.
Who can M80.061A be reported for?
The Medicare Code Editor checks age-related osteoporosis with current pathological fracture, right lower leg, 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.
What is the ICD-9 equivalent of M80.061A?
Under the General Equivalence Mappings, age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture converts to ICD-9-CM 733.16 (path fx tibia fibula). The mapping is approximate, so confirm the match fits the documentation.
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.
