Osteoporosis is a bone-thinning condition which causes loss of bone mass, making bones more vulnerable to fractures. Diverse medical specialists such as endocrinologists, orthopedists, and rheumatologists are involved in treating osteoporosis. Rheumatology medical coding involves reporting the condition using the right diagnosis and procedure codes. To assign the right codes, coders must know what type of osteoporosis the patient has been diagnosed with. Two categories of osteoporosis are primary and secondary. While the primary osteoporosis is age-related, secondary condition is caused by any underlying conditions. Primary osteoporosis can be further divided into “primary type I (postmenopausal osteoporosis)” and “primary type II (senile)” osteoporosis.

Causes of secondary osteoporosis can be endocrine disorders, malnutrition issues, marrow, renal or collagen disorders. Common risk factors for osteoporosis can be osteomalacia, aging, vitamin D deficiency, or hypocalcemia.

Diagnosis tests recommended to identify the right type of osteoporosis include DEXA scan, vertebral fracture assessment, and blood tests. Treatment for osteoporosis may include orthopedic and medical treatment. Surgeries such as kyphoplasty or vertebroplasty may be recommended for patients experiencing painful vertebral compression fracture from this condition. Medications like bisphosphonates are used to treat osteoporosis and reduce the risk of fracture. Other treatments may include estrogen/hormone replacement therapy, and thyroid and parathyroid hormone therapy.

What Are the ICD 10 Codes for Osteoporosis?

Osteoporosis can occur with or without pathological fracture. Age-related osteoporosis with current pathological fracture includes Involutional osteoporosis, Postmenopausal osteoporosis, Senile osteoporosis, and Osteoporosis NOS. Other osteoporosis with current pathological fracture includes Drug induced osteoporosis, Idiopathic osteoporosis, Osteoporosis of disuse, Post-oophorectomy osteoporosis, Postsurgical malabsorption osteoporosis, and Posttraumatic osteoporosis.

Osteoporosis with current pathological fracture

Age-related osteoporosis or other osteoporosis, with current pathological fracture can be reported usingM80 series of codes. Codes are selected based on the anatomical site of the fracture, not the location of the osteoporosis.

  • M80 Osteoporosis with current pathological fracture.

    • M80.0 Age-related osteoporosis with current pathological fracture

      • M80.00 Age-related osteoporosis with current pathological fracture, unspecified site
      • M80.01 Age-related osteoporosis with current pathological fracture, shoulder

        • M80.011 Age-related osteoporosis with current pathological fracture, right shoulder
        • M80.012 Age-related osteoporosis with current pathological fracture, left shoulder
      • M80.02 Age-related osteoporosis with current pathological fracture, humerus

        • M80.021 Age-related osteoporosis with current pathological fracture, right humerus
        • M80.022 Age-related osteoporosis with current pathological fracture, left humerus
      • M80.03 Age-related osteoporosis with current pathological fracture, forearm

        • M80.031 Age-related osteoporosis with current pathological fracture, right forearm
        • M80.032 Age-related osteoporosis with current pathological fracture, left forearm
      • M80.04 Age-related osteoporosis with current pathological fracture, hand

        • M80.041 Age-related osteoporosis with current pathological fracture, right hand
        • M80.042 Age-related osteoporosis with current pathological fracture, left hand
      • M80.05 Age-related osteoporosis with current pathological fracture, femur

        • M80.051 Age-related osteoporosis with current pathological fracture, right femur
        • M80.052 Age-related osteoporosis with current pathological fracture, left femur
      • M80.06 Age-related osteoporosis with current pathological fracture, lower leg

        • M80.061 Age-related osteoporosis with current pathological fracture, right lower leg
        • M80.062 Age-related osteoporosis with current pathological fracture, left lower leg
      • M80.07 Age-related osteoporosis with current pathological fracture, ankle and foot

        • M80.071 Age-related osteoporosis with current pathological fracture, right ankle and foot
        • M80.072 Age-related osteoporosis with current pathological fracture, left ankle and foot

    • M80.08 Age-related osteoporosis with current pathological fracture, vertebra(e)
    • M80.0A Age-related osteoporosis with current pathological fracture, other site
  • M80.8 Other osteoporosis with current pathological fracture

    • M80.81 Other osteoporosis with pathological fracture, shoulder
    • M80.82 Other osteoporosis with current pathological fracture, humerus
    • M80.83 Other osteoporosis with current pathological fracture, forearm
    • M80.84 Other osteoporosis with current pathological fracture, hand
    • M80.85 Other osteoporosis with current pathological fracture, femur

Osteoporosis without current pathological fracture

For osteoporosis without pathological fracture, codes from the M81 series can be used.

  • M81 Osteoporosis without current pathological fracture

    • M81.0 Age-related osteoporosis without current pathological fracture
    • M81.6 Localized osteoporosis [Lequesne]
    • M81.8 Other osteoporosis without current pathological fracture

While the sixth digit indicates laterality (right shoulder, left shoulder, unspecified shoulder), the seventh digit indicates the episode of care-

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

Osteoporosis fracture documentation involves definition of the episode of care (initial, routine, or delayed healing), specification of location and laterality (left or right), and precise classification for pathological fracture (Senile osteoporosis, posttraumatic osteoporosis). Providers treating this condition can consider the services provided by experienced medical billing and coding companies to submit their claims with up-to-date codes. Submitting accurate claims can prevent claim denials and ensure optimal reimbursement.