2027 ICD-10-CM Diagnosis Code M81.6Localized osteoporosis [Lequesne]
ICD-10-CM Codes›M00–M99›M80-M85›M81
- Billable — Valid for Submission
- Chronic Condition
M81.6 is a billable ICD-10-CM diagnosis code for localized osteoporosis [Lequesne]. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 553 through 554. Coders also document this condition as localized osteoporosis - Lequesne. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Osteoporosis.
M81.6 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 87 for payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
M81.6 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model, but it maps to payment categories in the other CMS models shown below.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Localized osteoporosis - Lequesne
- Secondary localized osteoporosis
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M81.6: its own notes plus those printed at M81 and Chapter 13. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- Sudeck's atrophy (M89.0)
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.
- 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
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name M81.6, its category, or a range that includes it.
Code First 1
These codes say to code first a condition named in the note, and M81.6 is one of the conditions named.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Osteoporosis
Osteoporosis is a disease in which your bones become weak and are likely to fracture (break). The disease can develop when your bone mineral density and bone mass decrease. It can also happen if the structure and strength of your bones change.
The full article covers:
- What is osteoporosis?
- What causes osteoporosis?
- Who is more likely to develop osteoporosis?
- What are the symptoms of osteoporosis?
- How is osteoporosis diagnosed?
- What are the treatments for osteoporosis?
- Can osteoporosis be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert M81.6 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M81.6Overview
What is the ICD-10 code for localized osteoporosis [Lequesne]?
The ICD-10-CM code for localized osteoporosis [Lequesne] is M81.6 (sometimes written as M816). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is M81.6 (Osteoporosis without current pathological fracture) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report localized osteoporosis [Lequesne] on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does M81.6 group to?
When localized osteoporosis [Lequesne] is the principal diagnosis on an inpatient stay, it groups to MS-DRG 554, 553, with relative weights from 0.8328 to 1.2492 depending on complications. Higher weights mean higher Medicare reimbursement.
Can M81.6 be reported with M89.0?
Not as a rule. The Excludes1 note on M81.6 lists "Sudeck's atrophy (M89.0)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
Does M81.6 need an additional code?
When the condition applies, yes. The Use Additional Code note at M81, which applies to M81.6, reads: code to identify: major osseous defect, if applicable (M89.7-); personal history of (healed) osteoporosis fracture, if applicable (Z87.310). The additional code is reported after M81.6.
Does M81.6 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage: M81.6 maps to no category in the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 87 (Osteoporosis, Vertebral and Pathological Fractures).
