2026 ICD-10-CM Diagnosis Code M80.811GOther osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing

ICD-10-CM Codes›M00–M99›M80-M85›M80

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

M80.811G is a billable ICD-10-CM diagnosis code for other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing. The 7th character G reports a subsequent encounter for a fracture that is healing more slowly than expected. 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 exempt from POA reporting. Coders also document this condition as osteoporotic fracture of clavicle. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pathological fracture, subsequent encounter.

Code Identity

ICD-10-CM Code
M80.811G
Billable Status
Yes — Valid for Submission
Code Describes
Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing
Short Description
Oth osteopor w crnt path fx, r shldr, 7thG
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 CodeM80.811GOther osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing

Present on Admission (POA)Billing

M80.811G 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.

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

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 M80.811G 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 M80.811GOverview

Is M80.811G a billable code?

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

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

The final character G reports a subsequent encounter where the other osteoporosis with current pathological fracture, right shoulder is healing more slowly than expected.

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

When other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed 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.

Is M80.811G 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 other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing on inpatient claims.

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

Under the General Equivalence Mappings, other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing converts to ICD-9-CM V54.21 (aftercare path fx up arm). 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.