Osteoporosis ICD 10: M81.0, M80 & Coding Rules

The ICD-10-CM code for age-related osteoporosis without a current pathological fracture including postmenopausal osteoporosis is M81.0. Use the complete M80 code for osteoporosis with a current pathological fracture. M81.8 is used for other specified types of osteoporosis without a current pathological fracture. The code Z13.820 is assigned for an osteoporosis screening. The choice is determined by the condition and/or the reason for the encounter.

Quick-Reference Osteoporosis Code Table

This table will help you locate the correct starting point. A code family ending in a dash contains multiple characters, and is thus, incomplete. It’s not a complete diagnosis code for submission.

M81.0, M81.6, and M81.8 are complete codes. M80 and M81 alone are categories. This is important when a search result shows a heading that appears to be a usable code.

A Practical Code-Selection Sequence

Read the assessment and reason for encounter before selecting a code. Then complete the following checks:

• What is the purpose? Is the service for screening, concern evaluation, management of diagnosed osteoporosis, or fracture management?
• What is the status of the fracture? Is it a pathological fracture due to osteoporosis that is current, healing, or completely healed? Is there a remaining problem from a completely healed pathological fracture?
• What is the type of osteoporosis documented? Is it age-related, postmenopausal, localized, drug-induced, or other?
• What are the details of the fracture? For M80, complete the site of the fracture, laterality, and seventh character.
• Are there notes? Review inclusion and exclusion terms, additional-code instructions, and the rules governing sequence and latitude.
• Is the encounter correct? Check the code-set version, and evaluate the documentation of the service reported against the version of the code-set.

There are three different questions: Is the code valid? Is the record supporting the code complete? Is the payer going to reimburse for the service?

An example to illustrate is: An electronic claim may accept a complete M81.0 for a osteoporotic fracture, and the chart may document the fracture as currently healed. A well supported diagnosis does not change a payer’s frequency limit for reimbursing the test. Keep coding review and coverage review separate.

Use the US Code Set for US Claims

IC-10 and IC-10 CM are not the same. WHO is the international organization for classifications, and NCHS is the National Center for Health Statistics, which manages the US clinical modification for diagnosis coding. Foreign versions of classification may be correct for their audience, and may be inapplicable for your purpose.

At this time, FY 2027 is the appropriate edition. CMS has stated the fiscal year window is October 1, 2026 through September 30, 2027. Use the edition released for the outpatient visit or inpatient discharge and check for mid-year updates or errata.

There are a number of sources online that give M81.1 for postmenopausal osteoporosis, M81.4 for drug induced osteoporosis, or M81.9 for osteoporosis, unspecified. These are invalid codes in the verified FY 2027 US ICD-10-CM. M82 is not a category in that edition of the US ICD-10-CM.

Recent date of publication for an article does not validate a code. Check for the complete code, edition, and jurisdiction, and instructions in the official publications.

Clinical Context That Helps You Read the Record

Osteoporosis reduces the strength of the bone and increases the risk of fracture. It can be undiagnosed until a fracture occurs. It is a natural process of aging as well as menopause. Some medical conditions and medications can increase the risk of developing osteoporosis. However, a risk factor doesn’t always lead to a diagnosis of osteoporosis.

Bone mineral density (BMD) is measured by a type of X-ray called a DXA or DEXA scan. Healthcare practitioners will consider other information such as a patient’s personal and medical history and risk factors. Fractures can occur due to many reasons and a DXA scan won’t always be done to determine a cause.

Some DXA scans may be done as part of an osteoporosis screening program. Others may be requested to support the diagnosis of osteoporosis, determine the cause of a fracture, or evaluate the effectiveness of osteoporosis treatment. Not all DXA scans are done for the purpose of osteoporosis screening.

Osteopenia and Osteoporosis Are Different Diagnoses

For postmenopausal women and men aged 50 or older, the usual T-score categories are:

These thresholds do not apply universally for pediatric or adult populations less than 40 years of age. In select cases, a clinician may diagnose osteoporosis due to fracture history and the overall clinical picture, even if the T-score is greater than -2.5.

For coding purposes, do not assign a diagnosis of osteoporosis based on laboratory or imaging results. Follow the documented assessment and stated reason for the responsible provider. Osteopenia is found in the Alphabetic Index under M85.8-. If the documented site of the osteopenia is not specified, select M85.80. If there is osteopenia at more than one site, M85.89 should be assigned. None of these codes should be assigned in lieu of a diagnosis of osteoporosis.

M81.0: Age-Related and Postmenopausal Osteoporosis

M81.0 indicates age-related osteoporosis in the absence of current pathological fracture. This includes postmenopausal, senile, and involutional osteoporosis, as well as other unspecified cases. M81.0 is also used to report cases of osteoporosis in the absence of current pathological fracture. In the field of professional healthcare services, such as pathology billing services, coding M81.0 helps operations to comply with regulations, and ensures patient records are complete and correct when no active fractures are noted.

Unspecified Osteoporosis Can Index to M81.0

The Index default for “osteoporosis” is M81.0. You don’t need to create an M81.9 code if the provider did not state the reason for the osteoporosis. Follow the Index. Confirm the Tabular entry and check the record for information that changes the reason for the selection.

The Default Permits No Current Fractures

That default permits you to ignore a documented current fracture. If the assessment of osteoporosis is contrary to the imaging study and fracture treatment, and/or another provider’s note, you need to obtain clarification through your organization’s query process.

Age, Sex, Anatomic Site do not Replace the Diagnosis

M81.0 is for both sexes and does not establish a lower age limit for the patient. The documented condition and Index direction control the selection. A payer or software’s demographic edit requiring an unsupported change to the diagnosis is not justified.

M81 codes are for systemic osteoporosis and do not distinguish between right and left, or between the hip and spine. A DXA report may show differing results for various areas; however, you cannot increase M81.0 to cover each and every site. Site detail becomes important when selecting a fracture code.

M81.0 may be first-listed when it explains the reason for the visit and may also be first-listed when osteoporosis is being managed (i.e. for administration of IV bisphosphonate). It is not always first-listed just because it is documented in the chart. Report and sequence the diagnoses according to the encounter and applicable instructions.

M81.8 and M81.6: Keep the Distinction Clear

M81.8 contains other osteoporoses not currently producing a pathological fracture. The drug-induced, idiopathic, disuse, post-oophorectomy, postsurgical malabsorption, and post-traumatic osteoporoses are specifically included.

M81.6 contains localized osteoporosis (Lequesne). Select this term if the diagnosis is specific to one region, but don’t choose it solely because a DXA report gives a region. Also, don’t choose regional or disuse osteoporosis, as the Index specifies these to M81.8.

When you encounter this type of coding pathway, it is good to slow down and check the wording of the documented diagnosis. It’s possible one of the regional or disuse osteoporoses is listed, but that doesn’t always mean you’ll be coding for localized osteoporosis. Depending on what the wording of the documented diagnosis is, you may be coding for something completely different.

Keep in mind that contributing disease and surgery can also cause bone loss. If this is documented, follow the instructions, and the Index. Don’t automatically code everything to a single remembered code (e.g. “osteoporosis”). Likewise, don’t code an adverse effect of a drug because it’s documented on the list of drugs that person is taking.

M80: Osteoporosis With a Current Pathological Fracture

M80 codes combine osteoporosis with pathological fractures. The main codes in this category are M80.0 for age-related osteoporosis and M80.8 for other osteoporoses. The remaining characters specify the type of fracture and detail the encounter.

A Minor Fall Does Not Indicate an Injury or Fracture

The formal rule states that if a patient with known osteoporosis fractures after a minor fall or trauma in which a healthy individual typically wouldn’t break a bone, M80 should be assigned rather than a traumatic fracture code.

Just using the word “fall” to make the classification determination is insufficient. Look at the mechanism of injury, diagnosis and fracture assessment. If trauma is of a high enough magnitude to cause a fracture of the affected bone in an osteoporotic patient, an injury code should be assigned and osteoporosis should be reported as a separate condition when appropriate. The same holds true for conflicting or ambiguous information; in these cases, contact the provider to get a determination rather than assuming.

Assign the Code to the Fractured Bone

The M80 site identifies the fracture, not the region of lowest DXA measurement. Documented femoral and pelvic fractures do not have to be described by the same site branch just because both may be referred to, in conversation, as hip-area injuries.

Examples of complete age-related fracture codes include:

• M80.051A: Right femur, initial encounter for fracture.
• M80.052A: Left femur, initial encounter for fracture.
• M80.08XA: Vertebra/vertebrae, initial encounter for fracture.

Each code includes age-related osteoporosis with a current pathological fracture. The X in the code for the vertebra/vertebrae represents a place holder and allows A to be in the seventh position. The decimal is not included in the character count.

M80 is already a combination-code pathway. Don’t routinely add a traumatic fracture code (M81) to the same osteoporotic fracture to represent the underlying osteoporosis. Consider the applicable exclusions and read them prior to reporting additional diagnoses.

Seventh Characters Follow Treatment and Healing

The seventh character describes the phase of care or healing status. It doesn’t simply count visits.

A patient who is having a routine recovery visit may or may not need to see a new clinician with D. A patient who is currently under active fracture treatment may still need to see a clinician with A for a follow-up visit, even after an earlier visit at a different location. So don’t solely base your choice on the patient’s appointment label.

Care for fracture healing remains on the fracture code pathway. Just because a post-op visit occurs, it doesn’t mean the fracture is healed, and a subsequent visit doesn’t mean it is an M81 visit.

For sequelae, focus on the actual condition that remains. In general, the condition is first sequenced and then the fracture code with S, based on specific instructions. S does not mean any old fracture and cannot be used as a history code when no residual problem is being treated.

Healed Fractures, History, and Ongoing Osteoporosis

If there is no current pathological fracture, the first description of continuing osteoporosis is provided by M81. The Z87.310 code is to be placed after M81, in cases where there is a documented history of a healed osteoporotic fracture.

Z87.310 describes a history of fractures. The presence of osteoporosis does not describe a fracture as being traumatic. Likewise, the absence of osteoporosis does not describe a fracture as being pathological.

Ensure these distinctions are maintained in the chart:

• Current or healing fracture: Assign the appropriate M80 code and encounter type.
• Healed fracture without treated residual: Assign both M81 and Z87.310 if warranted.
• Residual problem of a prior fracture: Assign the diagnosis and residual problem sequelae of the fracture.

The presence of a carried forward problem-list entry may cover the residual fracture problem. Assess whether the current examination document describes healing, completed healing or an ongoing residual problem. Healing may take time, and the lapse of a set number of weeks may not describe healing.

Screening, Diagnostic Testing, and Treatment Monitoring

Identifies a screening encounter for osteoporosis. Screening is done to find disease in a person who does not have the symptoms and signs of the disease. Evaluating a clinical concern or monitoring a known case of osteoporosis serves a different purpose.

The same DXA machine can be used for all 3 situations. The machine doesn’t determine the diagnosis code; the reason for the test and findings do.

A Positive Screening Result Doesn’t Eliminate the Need for Screening

When the purpose is for a screening test, the screening code may be first-listed. For the circumstances when a condition is discovered, the official guidelines allow for the condition to be reported as an additional diagnosis. Don’t automatically substitute the screening code with the condition code for a positive-result case.

Use the appropriate setting-specific code and final code. The purpose of the later, subsequent visit, which is to discuss and manage the diagnosed condition of osteoporosis, is different from the purpose of the screening visit.

Family history may indicate a person is at a higher risk for developing the condition, but family history doesn’t define the presence of the condition. Z82.62 may capture family history. This does not replace Z13.820 for the screening purpose, or M81 for a case that is supported by the evidence.

For outpatient situations, uncertain diagnosis does not mean to code for ‘possible’ or ‘rule out’ osteoporosis. Report the reason for the visit, findings, and/or symptoms. For inpatient situations, uncertain diagnosis rules may be different. Neither a screening code nor a diagnosis code should be selected to justify payment.

Excludes1 and Excludes2 in Plain Language

Exclusion notes tell you that a diagnosis belongs in a different category or that another condition could be reported separately. You should look at the notes at the subcategory level and the category level and not just at the level of the code that is presented.

Excludes 1: Don’t Duplicate the Same Clinical Condition

An Excludes 1 note tells you that the condition should not be reported with the code that is above the note. In the guidelines, it is recognized that there may be times where the conditions are really unrelated and an exception to the rule is appropriate; however, unrelated conditions should be reported if it is unclear.

At M81 (Osteoporosis), Excludes 1, a current pathological fracture, M80, is listed. In this case, you should not report M81 for a bone that is unfractured, and M80 for a bone that is fractured to describe the same systemic osteoporosis twice.

M81 excludes Sudeck’s atrophy, which is indexed under M89.0. At M80, there is an Excludes 1 for a wedged or collapsed NOS vertebra and a pathological fracture NOS. A more general description of the fracture should not be reported as an independent diagnosis.

Excludes 2: A Separate Condition Can Co-exist

An Excludes 2 note tells you the condition listed is not represented in the code, but may be reported if it is present.

M80 has an Excludes 2 note for Z87.310. This means that a patient may have a new, current, osteoporotic fracture, and also have a separate, older, healed, osteoporotic fracture. The history code should not describe the new fracture and state that it is healed.

In addition, follow the additional-code guidelines. M80 and M81, in cases where a major osseous defect is present, state that history of a healed osteoporotic fracture should be reported and M81 states that a history of a healed osteoporotic fracture should be reported; however, this does not mean a diagnosis of osteoporosis should be reported if it does not exist.

Drug-Induced Osteoporosis and Adverse-Effect Sequencing

For documented drug-induced osteoporosis, without a current pathological fracture, the code is M81.8. If a patient does have a pathological fracture, the coder should look through the full code family for M80.8 and assign the most appropriate, supported by the record.

In gastroenterology billing services, this comes up when there is long-term steroid use related to GI conditions. If the medication is documented as causing an adverse effect, the condition is coded first, and the drug-induced adverse effect is coded second. For glucocorticoids and synthetic analogs, T38.0X5- may apply, however the code is still incomplete and needs the correct encounter.

Long-term use of steroids, reported as Z79.52, does not indicate drug-induced osteoporosis. The documentation needs to show that the osteoporosis is because of the medication. A history of the medication, a risk factor or possible adverse effect of the medication does not allow for drug induced osteoporosis to be coded.

Documentation Tips That Resolve Coding Questions

The strongest note changes the code selection. It doesn’t need to repeat the code book. It can include other unsupported information, including speculation, reasoning, and judgement. Unsupported diagnostic language will be penalized.

Review the current assessment with relevant imaging, operative notes, and prior documentation of fracture. The objective is to determine the correct diagnosis as supported by the complete record, not to select the entry which is the most specific.

Use Neutral Queries When the Record Conflicts

An example of a clarification request could be: “The assessment states osteoporosis and a femoral fracture following a standing height fall. Please clarify the classification of the fracture in regard to osteoporosis, if known.”

Follow the compliant query policy of your organization. Do not suggest a diagnosis because it pays more and allow clinically appropriate responses, i.e. another diagnosis or no response.

Another check is to review the old problem list and see if it corresponds with the current encounter. A note stating “history of fracture” can exist with an active follow-up for a fracture elsewhere in the record. You will need to address the discrepancy and change the code to a history code.

For outpatient coding, a suspicion of a diagnosis and a confirmed diagnosis are typically treated differently. When you need clarification, always request it, however, be sure to follow the rules and regulations concerning the reporting of information.

DXA Procedure Codes and Coverage Checks

IC-10 CM contains the coding of diagnosis or reason of encounter. CPT and HCPCS codes describe the service or item. The relationship between ICD-10-CM and CPT/HCPCS should reflect the care delivered.

These summaries only cover some of the CPT descriptors. They are not automatic payable combinations. Verify the latest edition of the CPT, the documentary and bundling rules, and payer policy. For Medicare, verify the contractor policy, jurisdiction, and effective date of the policy.

Medicare Eligibility and Frequency Are Separate Checks

Medicare Part B generally covers bone mass measurements for eligible patients every 2 years. Frequency may be increased if medically necessary. There are various situations that would make a patient eligible, which may include: qualifying estrogen deficiency and risk; certain imaging findings; steroid treatment; primary hyperparathyroidism; or monitoring osteoporosis drug therapy.

Not all patients will have this service automatically provided if there is a claim with a diagnosis of M81.0 (osteoporosis) or Z13.820 (other and unspecified conditions originating in the perinatal period). The patient may have a qualifying indication, but may not meet the coverage criteria. Beneficiaries generally do not have cost-sharing responsibilities for this service, but there may be costs associated with unrelated or non-covered services.

Ensure the order is correct, prior test date is documented, the study was performed, the diagnosis is appropriate and relevant, and any payer-specific requirements are met. Separately bill for drug administration and medication, if applicable.

Denials do not permit reporting a supported diagnosis as something payable. Verify coding is correct and coverage is authorized. Frequency may be an issue. Obtain the reason for the denial. If there are missing records, obtain those records. Otherwise, pursue the appropriate level of appeal.

Three Practice-Based Coding Scenarios

The following fictional case examples illustrate documentation methods and are not actual patient records or examples from a clinical practice.

1. Postmenopausal Osteoporosis with a Healed Fracture

A 72 year old patient presents for management of her osteoporosis. Her clinician documents her condition as postmenopausal osteoporosis, no current pathological fractures, and a fully healed osteoporotic wrist fracture from 3 years previously. There is no other residual problem from the fracture and no ongoing treatment for it.

Coding for this example would be M81.0, osteoporosis, and Z87.310, postmenopausal status.

Rationale: Because the patient has osteoporosis and a healed fracture and is not on treatment for the fracture, the documented healed fracture would be coded as Z87.310.

Record check: It is important to verify complete healing, as merely documenting a previous fracture is not sufficient. Other documentation and sequence would depend on the remainder of the encounter.

2. A Left Femur Fracture During Treatment

A 79 year old patient, who has age related osteoporosis, sustains a left femur fracture due to a minor fall. The treating clinician document an osteoporotic pathological fracture and initiated treatment.

Coding would be M80.052A.

Rationale: The code is for age-related osteoporosis, left pathological femur fracture and treatment. The minor fall does not require a code for a traumatic fracture for the same fracture.

At a routine healing visit after treatment is completed, if healing is documented, the code would be M80.052D. This would still be considered fracture care. Coding would not change to M81.0 just because treatment was completed, a different provider is caring for the patient or the patient has had surgery.

3. Osteoporosis Identified During a Screening Encounter

A patient undergoes an encounter for osteoporosis screening and does not have a documented diagnosis of osteoporosis. The clinician determines the final diagnosis to be osteoporosis without a current pathological fracture, based on the results of the screening.

Coding approach: Z13.820 can be retained first-listed for the screening encounter with the supported osteoporosis diagnosis, e.g., M81.0, coded under the screening guidelines.

Reasoning: Finding a condition does not always modify the nature of the original screening encounter to a visit for the management of that condition. A separate, later encounter for the management of osteoporosis has its own reason and sequencing.

Record check: Confirm the screening purpose and final diagnosis. Do not assign osteoporosis based on an unexplained score.

Common Coding Mistakes and Better Checks

As a quality check, review a small sample of recent osteoporosis encounters for each of the errors discussed above and track the reason for correction. This could be due to missing documentation, use of an incorrect code-set version, use of an incorrect encounter character, or a coverage misunderstanding. Tracking the reasons will provide a prioritized list of actions without assuming every rejection is the same.

Frequently Asked Questions

What is the ICD-10 code for osteoporosis without fracture?

M81.0 covers age-related osteoporosis without a current pathological fracture, including postmenopausal osteoporosis and osteoporosis NOS. Other documented types may require M81.6 or M81.8. The distinction concerns a current pathological fracture, not whether the patient has ever broken a bone.

What is the difference between M80 and M81?

M80 describes osteoporosis with a current pathological fracture and requires fracture details plus a seventh character. M81 describes osteoporosis without a current pathological fracture. A fracture that is still receiving healing care generally remains on the fracture-code pathway.

Is postmenopausal osteoporosis coded M81.0 or M81.1?

In the verified FY 2027 US ICD-10-CM edition, postmenopausal osteoporosis without a current pathological fracture is included in M81.0. M81.1 is not a valid US code in that edition. A current osteoporotic fracture changes the selection to the appropriate M80 pathway.

What does M81.8 mean?

M81.8 means other osteoporosis without a current pathological fracture. Its inclusion terms cover types such as drug-induced, idiopathic, and disuse osteoporosis. For a documented drug adverse effect, follow the additional-code and sequencing instructions.

What code is used for osteoporosis screening?

Z13.820 identifies an encounter for screening for osteoporosis. It isn’t the default code for monitoring established osteoporosis. If a condition is discovered during screening, it may be reported additionally under the applicable screening and setting-specific rules.

Is M81.0 a billable code?

Yes. M81.0 is a complete ICD-10-CM diagnosis code, unlike the M81 category heading. That doesn’t guarantee reimbursement: documentation, coverage, medical necessity, and other claim requirements still apply.

Put the Decision Into Practice

The first thing to do is determine the purpose of the encounter and the current status of the fracture. Next, select the documented type of osteoporosis, fill in any fracture characters, and read the instructional notes. Prior to submitting your next osteoporosis claim, compare your assessment to the quick-reference table and documentation checklist above. Resolve discrepancies to avoid claim corrections.

Sources and References

• CMS: FY 2027 ICD-10-CM Code Tables, Tabular List and Index
• CMS: FY 2027 ICD-10-CM Official Guidelines for Coding and Reporting
• CDC/NCHS: ICD-10-CM Overview and Coding Resources
• WHO: International Classification of Diseases
• NIH: Osteoporosis Diagnosis, Treatment, and Steps to Take
• Bone Health and Osteoporosis Foundation: Bone Density Testing
• Medicare: Bone Mass Measurement Coverage
• CMS: Billing and Coding for Bone Mass Measurement