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v1.0.0
ICD-10 Guide
ICD-10 CodesM81.8

M81.8

Billable

Other osteoporosis without current pathological fracture

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

Code Description

ICD-10 M81.8 is a billable code used to indicate a diagnosis of other osteoporosis without current pathological fracture.

Key Diagnostic Point:

Osteoporosis is a systemic skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to increased bone fragility and susceptibility to fractures. M81.8 refers specifically to cases of osteoporosis that do not currently involve a pathological fracture. This condition can arise from various factors, including hormonal changes, nutritional deficiencies (such as calcium and vitamin D), sedentary lifestyle, and certain medications. Patients may present with symptoms such as back pain, loss of height, or a stooped posture, although many remain asymptomatic until a fracture occurs. Diagnosis typically involves bone density testing (DEXA scans) to assess bone mineral density (BMD). Management strategies may include lifestyle modifications, dietary changes, and pharmacological treatments aimed at improving bone density and reducing fracture risk. Understanding the nuances of this code is essential for accurate documentation and coding, as it helps in tracking the prevalence of osteoporosis and guiding treatment protocols.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of osteoporosis (primary vs. secondary)
  • Understanding the absence of current pathological fractures
  • Identifying contributing factors such as medications or comorbidities
  • Proper documentation of bone density test results

Audit Risk Factors

  • Inadequate documentation of bone density tests
  • Failure to specify the type of osteoporosis
  • Misclassification of osteoporosis severity
  • Lack of supporting clinical evidence for diagnosis

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed history of hormonal status, bone density test results, and treatment plans.

Common Clinical Scenarios

Patients with osteoporosis due to hormonal imbalances, such as post-menopausal women.

Billing Considerations

Ensure documentation reflects the cause of osteoporosis and any related endocrine disorders.

Orthopedics

Documentation Requirements

Comprehensive assessment of bone health, including fracture history and imaging results.

Common Clinical Scenarios

Patients presenting with fractures or bone pain, requiring evaluation for underlying osteoporosis.

Billing Considerations

Document any surgical interventions or recommendations for physical therapy.

Coding Guidelines

Inclusion Criteria

Use M81.8 When
  • Follow official ICD
  • CM guidelines for coding osteoporosis, ensuring accurate documentation of the absence of current fractures
  • Include relevant clinical information and risk factors to support the diagnosis

Exclusion Criteria

Do NOT use M81.8 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76977CPT Code

Bone density measurement

Clinical Scenario

Used for assessing bone density in patients suspected of having osteoporosis.

Documentation Requirements

Include results of the bone density test and any relevant clinical history.

Specialty Considerations

Endocrinologists should document hormonal assessments alongside bone density results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of osteoporosis, improving the ability to track and manage the condition. M81.8 provides a clear distinction for cases without current fractures, aiding in appropriate treatment and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of osteoporosis, improving the ability to track and manage the condition. M81.8 provides a clear distinction for cases without current fractures, aiding in appropriate treatment and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of osteoporosis, improving the ability to track and manage the condition. M81.8 provides a clear distinction for cases without current fractures, aiding in appropriate treatment and resource allocation.

Resources

Clinical References

  • •
    National Osteoporosis Foundation

Coding & Billing References

  • •
    National Osteoporosis Foundation

Frequently Asked Questions

What is the difference between M81.8 and M80.x codes?

M81.8 is used for osteoporosis without current pathological fractures, while M80.x codes are for osteoporosis with current fractures. Accurate coding depends on the presence or absence of fractures.