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M80

Non-Billable (Header)

Osteoporosis with current pathological fracture

Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)

What This Code Means

M80 is the ICD-10-CM diagnosis code for osteoporosis with current pathological fracture. M80 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering disorders of bone density and structure (m80-m85).

Header codes like M80 cannot be reported on claims directly — they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at M80's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M80 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Includes

  • osteoporosis with current fragility fracture

Excludes 1 — Do NOT code together

  • collapsed vertebra NOS (M48.5)
  • pathological fracture NOS (M84.4)
  • wedging of vertebra NOS (M48.5)

Excludes 2 — Not included here, may code separately

  • personal history of (healed) osteoporosis fracture (Z87.310)

Use Additional Code

  • code to identify major osseous defect, if applicable (M89.7-)

Child Codes

Code Hierarchy

M80Osteoporosis with current pathological fracture
M80Osteoporosis with current pathological fracture

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