M80.019K — Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with nonunion
Is M80.019K billable?
Yes, but M80.019K will trip a Medicare edit. M80.019K is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists M80.019K under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
M80.019K at a glance
| Code | M80.019K |
|---|---|
| Description | Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with nonunion |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "K" | subsequent encounter for fracture with nonunion |
What does the 7th character "K" mean in M80.019K?
In M80.019K, the 7th character K means subsequent encounter for fracture with nonunion. The 7th character is required for M80.019K to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
What Medicare edits apply to M80.019K?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name M80.019K directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does M80.019K group to?
M80.019K sits in MDC 08 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 564Other Musculoskeletal System and Connective Tissue Diagnoses with MCCmedical
- 565Other Musculoskeletal System and Connective Tissue Diagnoses with CCmedical
- 566Other Musculoskeletal System and Connective Tissue Diagnoses without CC/MCCmedical
As a secondary diagnosis, M80.019K is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is M80.019K listed in the Alphabetic Index?
The Alphabetic Index lists these routes under M80.01, the nearest indexed parent of M80.019K. Use them to find the family, then select the specific code.
- Osteoporosis › age-related › with current pathologic fracture › clavicle (female) (male)
- Osteoporosis › age-related › with current pathologic fracture › scapula (female) (male)
- Osteoporosis › postmenopausal › with pathological fracture › clavicle (female) (male)
- Osteoporosis › postmenopausal › with pathological fracture › scapula (female) (male)
Excludes1 — never code together — inherited from M80
The conditions below can never be reported together with M80.019K on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
Use additional code — inherited from M80
Report an additional code alongside M80.019K to fully describe the condition. M80.019K is sequenced first.
- code to identify major osseous defect, if applicable (M89.7-)
Excludes2 — not included here — inherited from Chapter 13
The conditions below are not part of M80.019K, but a patient may have both at the same time. When documentation supports it, M80.019K and the excluded code may both 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)
Excludes2 — not included here — inherited from M80
The conditions below are not part of M80.019K, but a patient may have both at the same time. When documentation supports it, M80.019K and the excluded code may both be reported.
- personal history of (healed) osteoporosis fracture (Z87.310)
How long has M80.019K existed?
M80.019K has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.