M80.859A — Other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture
Is M80.859A billable?
Yes, but M80.859A will trip a Medicare edit. M80.859A is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists M80.859A 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.
M80.859A at a glance
| Code | M80.859A |
|---|---|
| Description | Other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "A" | initial encounter for fracture |
What does the 7th character "A" mean in M80.859A?
In M80.859A, the 7th character A means initial encounter for fracture. The 7th character is required for M80.859A to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
What Medicare edits apply to M80.859A?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name M80.859A 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 M80.859A group to?
M80.859A sits in MDC 08 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 521Hip Replacement with Principal Diagnosis of Hip Fracture with MCCsurgical
- 522Hip Replacement with Principal Diagnosis of Hip Fracture without MCCsurgical
As a secondary diagnosis, M80.859A is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is M80.859A listed in the Alphabetic Index?
The Alphabetic Index lists these routes under M80.85, the nearest indexed parent of M80.859A. Use them to find the family, then select the specific code.
- Osteoporosis › disuse › with current pathological fracture › femur (female) (male)
- Osteoporosis › disuse › with current pathological fracture › hip (female) (male)
- Osteoporosis › specified type NEC › with pathological fracture › femur (female) (male)
- Osteoporosis › specified type NEC › with pathological fracture › hip (female) (male)
Excludes1 — never code together — inherited from M80
The conditions below can never be reported together with M80.859A 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 M80.859A to fully describe the condition. M80.859A is sequenced first.
- code to identify major osseous defect, if applicable (M89.7-)
Use additional code — inherited from M80.8
Report an additional code alongside M80.859A to fully describe the condition. M80.859A is sequenced first.
- code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
Excludes2 — not included here — inherited from Chapter 13
The conditions below are not part of M80.859A, but a patient may have both at the same time. When documentation supports it, M80.859A 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 M80.859A, but a patient may have both at the same time. When documentation supports it, M80.859A and the excluded code may both be reported.
- personal history of (healed) osteoporosis fracture (Z87.310)
How long has M80.859A existed?
M80.859A 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.