2026 ICD-10-CM Diagnosis Code M80.811AOther osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture

ICD-10-CM Codes›M00–M99›M80-M85›M80

ICD-10-CM M80.811A
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

M80.811A is a billable ICD-10-CM diagnosis code for other osteoporosis with current pathological fracture, right shoulder, 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. Coders also document this condition as osteoporotic fracture of clavicle. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Osteoporosis; and Pathological fracture, initial encounter.

Code Identity

ICD-10-CM Code
M80.811A
Billable Status
Yes — Valid for Submission
Code Describes
Other osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
Short Description
Oth osteopor w current path fracture, r shoulder, init
Parent Code
M80.811
Other osteoporosis with current pathological fracture, right shoulder

Code Classification

ChapterM00–M99Diseases of the musculoskeletal system and connective tissue
SectionM80-M85Disorders of bone density and structure
CategoryM80Osteoporosis with current pathological fracture
This CodeM80.811AOther osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture

Quality Payment Program MeasuresBilling

Medicare quality measures that can apply when M80.811A 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.

View Measure

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.

View Measure

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Osteoporotic fracture of clavicle
  • Pathological fracture of right clavicle due to secondary osteoporosis
  • Secondary osteoporotic fracture of clavicle
  • Stress fracture of clavicle
  • Stress fracture of right clavicle

Clinical ClassificationClinical

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

CCSR MUS013
Osteoporosis
Default principal diagnosis: inpatient Yes · outpatient Yes
CCSR MUS014
Pathological fracture, initial encounter
Default principal diagnosis: inpatient No · outpatient No

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 M80.811A to ICD-9-CMHistory

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

ICD-9-CM
733.19 Path fx oth specif site
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 M80.811AOverview

Is M80.811A a billable code?

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

What does the 7th character A in M80.811A mean?

The final character A marks the initial encounter: use it while the patient is receiving active treatment for other osteoporosis with current pathological fracture, right shoulder, such as an emergency visit or first evaluation.

What MS-DRG does M80.811A group to?

When other osteoporosis with current pathological fracture, right shoulder, 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.

What is the ICD-9 equivalent of M80.811A?

Under the General Equivalence Mappings, other osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture converts to ICD-9-CM 733.19 (path fx oth specif site). 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.