ICD-10-CM Billable Code

M80.81

Other osteoporosis with pathological fracture, shoulder

Clinical Classification Guidelines

Medical Intelligence & Overview

Osteoporosis is a condition characterized by weakened bones that are more prone to fractures. When osteoporosis leads to fractures due to minimal trauma, it is termed pathological fractures. The ICD-10 code M80.81 specifically refers to osteoporosis with a pathological fracture of the shoulder. This condition primarily affects older adults and individuals with severe bone density loss, significantly impacting mobility and quality of life.

Causes & Symptoms

Clinical Causes: Aging: Natural decline in bone density as part of the aging process. Hormonal imbalances: Especially decreased estrogen in postmenopausal women and reduced testosterone in men. Nutritional deficiencies: Lack of calcium, vitamin D, and other essential nutrients needed for healthy bones. Sedentary lifestyle: Limited weight-bearing activity weakens bones over time. Chronic medical conditions: Such as rheumatoid arthritis, hyperthyroidism, and certain cancers. Use of medications: Long-term use of corticosteroids and other drugs that can decrease bone density. Genetic factors: Family history of osteoporosis or fractures. Lifestyle factors: Smoking and excessive alcohol consumption can contribute to bone loss.

Key Symptoms: Pain around the shoulder, which may worsen with movement or pressure. Swelling or tenderness over the shoulder area. Reduced range of motion or difficulty moving the shoulder. Visible deformity if the fracture causes misalignment. Weakness or loss of strength in the affected arm. Possible numbness or tingling if nerves are affected. In severe cases, decreased mobility and difficulty with daily activities.

Diagnostic & Treatment

Diagnosis Path: Diagnosis involves a combination of physical examination and imaging studies. Medical practitioners may perform the following assessments:

Treatment Protocols: Treatment aims to promote healing, prevent further bone loss, and restore shoulder function. Typical approaches include:

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 M80.81 a billable ICD-10 code?
Yes, M80.81 is a specific, billable code that can be used to indicate a diagnosis for reimbursement purposes.

Documentation

How do I report M80.81?
Clinical documentation must specify the nature of Other osteoporosis with pathological fracture, shoulder and any associated comorbidities for accurate reporting.

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