2027 ICD-10-CM Diagnosis Code M80.0B1DAge-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing
ICD-10-CM Codes›M00–M99›M80-M85›M80
- Billable — Valid for Submission
- POA Exempt
- 7th Character D — Subsequent Encounter
- Chronic Condition
M80.0B1D is a billable ICD-10-CM diagnosis code for age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing. The 7th character D means subsequent encounter for fracture with routine healing, used during routine care in the healing or recovery phase. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 521 through 522, 559 through 561. The code is restricted by the Medicare Code Editor to adult patients (age 15 through 124) and exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pathological fracture, subsequent encounter.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for M80.0B1D.
Present on Admission (POA)Billing
M80.0B1D is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Disorders of bone density and structure (M80-M85).
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when M80.0B1D 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.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M80.0B1D: 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
- Dsubsequent encounter for fracture with routine healing this code
- 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 M80.0B1D, its category, or a range that includes it.
Excludes1 9
These codes carry an Excludes1 note naming M80.0B1D: 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 M80.0B1D: 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 M80.0B1D is one of the conditions named.
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.
Code History & ChangesHistory
Replacement M80.0B1D replaces the following previously assigned code(s):
- M80.0AXD - Age-rel osteopor with current path fx, other site, 7thD
Questions About M80.0B1DOverview
Is M80.0B1D a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character D in M80.0B1D mean?
The final character D marks a subsequent encounter: use it for routine care while the age-related osteoporosis with current pathological fracture, right pelvis is healing, after active treatment has ended. In this category the CMS Tabular List defines D as "subsequent encounter for fracture with routine healing".
What MS-DRG does M80.0B1D group to?
When age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing is the principal diagnosis on an inpatient stay, it groups to MS-DRG 559, 521, 522, 561, 560, with relative weights from 0.8258 to 2.8516 depending on complications. Higher weights mean higher Medicare reimbursement.
Who can M80.0B1D be reported for?
The Medicare Code Editor checks age-related osteoporosis with current pathological fracture, right pelvis, 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 M80.0B1D 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 pelvis, subsequent encounter for fracture with routine healing on inpatient claims. The code appears in the Disorders of bone density and structure (M80-M85) range of the CMS exempt list.
