ICD-10-CM Billable Code

M80.811

Other osteoporosis with current pathological fracture, right shoulder

Clinical Classification Guidelines

Medical Intelligence & Overview

Osteoporosis is a condition characterized by weakened bones that are more fragile and susceptible to fractures. When osteoporosis leads to a fracture, especially in the shoulder, it signifies a serious health concern. The ICD-10 code M80.811 specifies a case where a person has osteoporosis with a current pathological fracture in the right shoulder. This type of fracture occurs in bones that are already compromised due to underlying disease, in this case, osteoporosis. Recognizing this condition is vital for appropriate treatment and management to prevent further injuries.

Causes & Symptoms

Clinical Causes: Progressive loss of bone density over time due to aging Hormonal imbalances, such as decreased estrogen levels in women Nutritional deficiencies, particularly calcium and vitamin D deficiency Certain medications, including long-term corticosteroid use Medical conditions like hyperparathyroidism or rheumatoid arthritis Lifestyle factors such as smoking, excessive alcohol consumption, and sedentary lifestyle Genetic predisposition leading to lower peak bone mass

Key Symptoms: Pain in the affected shoulder, especially after a fall or injury Swelling or tenderness around the shoulder area Limited range of motion or difficulty moving the shoulder Visible deformity or abnormal positioning in severe cases Weakness or instability in the shoulder joint Possible numbness or tingling if nerves are affected

Diagnostic & Treatment

Diagnosis Path: Physical examination to assess pain, swelling, and mobility X-rays to identify fractures and bone quality Dual-energy X-ray Absorptiometry (DXA) scan to measure bone mineral density Blood tests to evaluate calcium, vitamin D levels, and markers of bone turnover Assessment of risk factors for osteoporosis and fracture.

Treatment Protocols: Pain management with medications such as acetaminophen or NSAIDs Immobilization of the shoulder using slings or braces to facilitate healing Surgical intervention may be necessary in severe fractures, including procedures like joint stabilization or replacement Bone-stimulating therapies and medications to strengthen bones, such as bisphosphonates or denosumab Physical therapy to restore mobility, strength, and function after initial recovery Addressing underlying causes through nutritional supplementation and lifestyle modifications Routine monitoring of bone density and fracture risk

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

Clinical Advice & FAQs

Billing Guidance

Is M80.811 a billable ICD-10 code?
Yes, M80.811 is a specific, billable code that can be used to indicate a diagnosis for reimbursement purposes.

Documentation

How do I report M80.811?
Clinical documentation must specify the nature of Other osteoporosis with current pathological fracture, right shoulder and any associated comorbidities for accurate reporting.

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