2026 ICD-10-CM Diagnosis Code M80.8B9AOther osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture

ICD-10-CM Codes›M00–M99›M80-M85›M80

ICD-10-CM M80.8B9A
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

M80.8B9A is a billable ICD-10-CM diagnosis code for other osteoporosis with current pathological fracture, unspecified pelvis, 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 521 through 522, 542 through 544. The code is flagged as an unspecified code, since codes identifying laterality exist in the same family. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Osteoporosis; and Pathological fracture, initial encounter.

Code Identity

ICD-10-CM Code
M80.8B9A
Billable Status
Yes — Valid for Submission
Code Describes
Other osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture
Short Description
Other osteopor with current path fracture, unsp pelvis, init
Parent Code
M80.8B9
Other osteoporosis with current pathological fracture, unspecified pelvis

Code Classification

ChapterM00–M99Diseases of the musculoskeletal system and connective tissue
SectionM80-M85Disorders of bone density and structure
CategoryM80Osteoporosis with current pathological fracture
This CodeM80.8B9AOther osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture

Code EditsBilling

Medicare Code Editor checks that affect claim validity for M80.8B9A.

Unspecified codes
Unspecified codes exist in the ICD-10-CM classification for circumstances when documentation in the medical record does not provide the level of detail needed to support reporting a more specific code. However, in the inpatient setting, there should generally be very limited and rare circumstances for which the laterality (right, left, bilateral) of a condition is unable to be documented and reported. The following pages contain the list of unspecified ICD-10-CM diagnosis codes for which there is a more specific code to identify laterality (right, left, bilateral) within that code family.

Quality Payment Program MeasuresBilling

Medicare quality measures that can apply when M80.8B9A 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

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

Code History & ChangesHistory

Replacement M80.8B9A replaces the following previously assigned code(s):

  • M80.80XA - Oth osteopor w current path fracture, unsp site, init
FY 2024AddedAdded to the ICD-10-CM code setEffective October 1, 2023.
FY 2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About M80.8B9AOverview

Is M80.8B9A a billable code?

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

What does the 7th character A in M80.8B9A 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, unspecified pelvis, such as an emergency visit or first evaluation.

What MS-DRG does M80.8B9A group to?

When other osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture is the principal diagnosis on an inpatient stay, it groups to MS-DRG 521, 522, 542, 543, 544, with relative weights from 0.7546 to 2.8702 depending on complications. Higher weights mean higher Medicare reimbursement.

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.