M80.859A Other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture

Billable ICD-10-CM code, FY2026.

Built from M80.859 with 7th character A (initial encounter for fracture).

Applies from M80 Osteoporosis with current pathological fracture

Includes

• osteoporosis with current fragility fracture

Excludes1 (never code together)

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

Excludes2 (not included here)

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

Use additional code

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

7th character note

• The appropriate 7th character is to be added to each code from category M80:

7th character required

• A — initial encounter for fracture
• D — subsequent encounter for fracture with routine healing
• G — subsequent encounter for fracture with delayed healing
• K — subsequent encounter for fracture with nonunion
• P — subsequent encounter for fracture with malunion
• S — sequela

Applies from M80.8 Other osteoporosis with current pathological fracture

Applicable to

• Drug-induced osteoporosis with current pathological fracture
• Idiopathic osteoporosis with current pathological fracture
• Osteoporosis of disuse with current pathological fracture
• Postoophorectomy osteoporosis with current pathological fracture
• Postsurgical malabsorption osteoporosis with current pathological fracture
• Post-traumatic osteoporosis with current pathological fracture

Use additional code

• code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Applies from M80.85 Other osteoporosis with current pathological fracture, femur

Applicable to

• Other osteoporosis with current pathological fracture of hip

Risk adjustment (HCC)

• CMS-HCC V28: HCC 402 — Hip Fracture/Dislocation
• CMS-HCC V22: HCC 170 — Hip Fracture/Dislocation
• RxHCC V08: HCC 87 — Osteoporosis, Vertebral and Pathological Fractures
• ESRD V24: HCC 170

Medicare Code Edits (MCE v43.1 (April 2026))

• Unspecified code (laterality): Unspecified codes for which a more specific code identifying laterality (right, left, bilateral) exists within the same code family.

Code annotations containing back-references to M80.859A

Back-references to M80.8

• Type 1 Excludes: K91.2 Postsurgical malabsorption, not elsewhere classified ("malabsorption osteoporosis, postsurgical (M80.8-, M81.8)")
• Type 2 Excludes: N99 Intraoperative and postprocedural complications and disorders of genitourinary system, not elsewhere classified ("postoophorectomy osteoporosis with current pathological fracture (M80.8-)")

Back-references to M80

• Type 1 Excludes: E55 Vitamin D deficiency ("osteoporosis (M80.-)")
• Type 1 Excludes: E83.3 Disorders of phosphorus metabolism and phosphatases ("osteoporosis (M80.-)")
• Type 1 Excludes: M43 Other deforming dorsopathies ("spinal curvature in osteoporosis (M80.-)")
• Type 1 Excludes: M48.4 Fatigue fracture of vertebra ("pathological fracture of vertebra due to osteoporosis (M80.-)")
• Type 1 Excludes: M48.5 Collapsed vertebra, not elsewhere classified ("pathological fracture of vertebra due to osteoporosis (M80.-)")
• Type 1 Excludes: M81 Osteoporosis without current pathological fracture ("osteoporosis with current pathological fracture (M80.-)")
• Type 1 Excludes: M84.3 Stress fracture ("pathological fracture due to osteoporosis (M80.-)")
• Type 1 Excludes: M84.4 Pathological fracture, not elsewhere classified ("pathological fracture in osteoporosis (M80.-)")
• Type 1 Excludes: M84.6 Pathological fracture in other disease ("pathological fracture in osteoporosis (M80.-)")
• Code First: M89.7 Major osseous defect ("osteoporosis (M80.-, M81.-)")
• Type 2 Excludes: M96 Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified ("disorders associated with osteoporosis (M80)")
• Type 1 Excludes: R29.890 Loss of height ("osteoporosis (M80-M81)")
• Code Also: Z91.B Personal risk factor of exposure to diethylstilbestrol ("osteoporosis (M80.-)")

Nearby codes

• M80.852G Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing
• M80.852K Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion
• M80.852P Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion
• M80.852S Other osteoporosis with current pathological fracture, left femur, sequela
• M80.859 Other osteoporosis with current pathological fracture, unspecified femur
• M80.859A Other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture (this code)
• M80.859D Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with routine healing
• M80.859G Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with delayed healing
• M80.859K Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with nonunion
• M80.859P Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with malunion
• M80.859S Other osteoporosis with current pathological fracture, unspecified femur, sequela