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ICD-10 Guide
ICD-10 CodesM81.6

M81.6

Billable

Localized osteoporosis [Lequesne]

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M81.6 is a billable code used to indicate a diagnosis of localized osteoporosis [lequesne].

Key Diagnostic Point:

Localized osteoporosis, also known as Lequesne's osteoporosis, is a condition characterized by a reduction in bone density in a specific area of the skeleton, rather than throughout the entire body. This localized form of osteoporosis can occur due to various factors, including disuse of a limb, localized inflammation, or as a consequence of certain diseases such as rheumatoid arthritis or Paget's disease. The condition is often asymptomatic until a fracture occurs, which can lead to significant morbidity. Diagnosis typically involves imaging studies such as dual-energy X-ray absorptiometry (DEXA) scans, which can reveal decreased bone mineral density in the affected area. Treatment may include weight-bearing exercises, nutritional support, and medications aimed at improving bone density. Understanding the underlying causes and the specific anatomical location of the osteoporosis is crucial for effective management and prevention of fractures, which are a common complication associated with this condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of localized versus generalized osteoporosis
  • Differentiation from other bone density disorders
  • Need for precise documentation of affected anatomical sites
  • Potential overlap with other ICD-10 codes related to osteoporosis

Audit Risk Factors

  • Insufficient documentation of the specific site of osteoporosis
  • Failure to document underlying conditions contributing to localized osteoporosis
  • Inaccurate coding due to confusion with generalized osteoporosis codes
  • Lack of imaging studies to support diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports and clinical notes describing the affected area and treatment plan.

Common Clinical Scenarios

Patients presenting with fractures in specific locations, often following minimal trauma.

Billing Considerations

Documentation should clearly indicate the relationship between localized osteoporosis and any fractures or surgical interventions.

Rheumatology

Documentation Requirements

Comprehensive history of autoimmune conditions and their impact on bone health.

Common Clinical Scenarios

Patients with rheumatoid arthritis experiencing localized bone density loss.

Billing Considerations

Consideration of systemic treatments that may affect bone density should be documented.

Coding Guidelines

Inclusion Criteria

Use M81.6 When
  • According to ICD
  • 10 coding guidelines, M81
  • 6 should be used when there is clear documentation of localized osteoporosis
  • It is important to include the specific site affected and any relevant clinical information that supports the diagnosis

Exclusion Criteria

Do NOT use M81.6 When
  • Exclusion criteria include generalized osteoporosis and conditions that do not specifically indicate localized bone density loss

Related ICD-10 Codes

Related CPT Codes

77080CPT Code

Dual-energy X-ray absorptiometry (DEXA) scan

Clinical Scenario

Used to assess bone density in patients suspected of localized osteoporosis.

Documentation Requirements

Report must include the specific site scanned and the reason for the scan.

Specialty Considerations

Orthopedic specialists should ensure that the DEXA results correlate with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of localized osteoporosis, improving the ability to track and manage this condition. The granularity of ICD-10 codes facilitates better clinical decision-making and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of localized osteoporosis, improving the ability to track and manage this condition. The granularity of ICD-10 codes facilitates better clinical decision-making and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of localized osteoporosis, improving the ability to track and manage this condition. The granularity of ICD-10 codes facilitates better clinical decision-making and resource allocation.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between localized osteoporosis and generalized osteoporosis?

Localized osteoporosis affects a specific area of the skeleton, while generalized osteoporosis involves a reduction in bone density throughout the entire skeleton. Localized osteoporosis may be due to disuse, inflammation, or specific diseases, whereas generalized osteoporosis is often age-related or due to systemic conditions.