Osteoporosis, a condition characterized by weakened bones prone to fractures, is a significant concern for individuals as well as the healthcare system. The International Classification of Diseases, 10th Revision (ICD-10), offers a comprehensive framework for coding and categorizing medical conditions, including osteoporosis. In this article, we navigate through the world of ICD-10 codes for osteoporosis, shedding light on its importance and implications for accurate healthcare management.
What is Osteoporosis?
Osteoporosis, often referred to as the “silent disease,” is characterized by weakened and brittle bones. It predominantly affects older individuals, particularly postmenopausal women, and can lead to fractures that significantly impact quality of life. Early diagnosis and proper management are crucial to prevent complications.
Subtypes of Osteoporosis
- Primary Osteoporosis: This is the most common form, occurring due to age-related bone loss.
- Secondary Osteoporosis: Caused by underlying medical conditions or medications.
- Juvenile Osteoporosis: Rare and usually genetic, affecting children and adolescents.
ICD-10 Codes for Osteoporosis
ICD-10 provides a systematic coding structure to accurately classify and document osteoporosis cases. The primary ICD-10 code for osteoporosis is “M81”, which falls under the category of “Disorders of Bone Density and Structure.” This code encompasses various types of osteoporosis, including postmenopausal osteoporosis (“M81.0”), senile osteoporosis (“M81.8”), and osteoporosis due to other causes (“M81.9”).
ICD-10 Codes for Primary Osteoporosis
- M80.0: Age-related osteoporosis without current pathological fracture.
- M80.8: Other osteoporosis with current pathological fracture.
- M81.0: Postmenopausal osteoporosis with current pathological fracture.
ICD-10 Codes for Secondary Osteoporosis
- M83.0: Drug-induced osteoporosis with current pathological fracture.
- M83.9: Juvenile osteoporosis, unspecified site, with current pathological fracture.
2023 ICD-10-CM Diagnosis Code M81.0
- M81.0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
- Short description: Age-related osteoporosis w/o current pathological fracture
- The 2023 edition of ICD-10-CM M81.0 became effective on October 1, 2022.
- This is the American ICD-10-CM version of M81.0 – other international versions of ICD-10 M81.0 may differ.
ICD-10-CM Coding Rules
- M81.0 is applicable to adult patients aged 15 – 124 years inclusive.
Applicable To
- Involutional osteoporosis without current pathological fracture
- Osteoporosis NOS
- Postmenopausal osteoporosis without current pathological fracture
- Senile osteoporosis without current pathological fracture
The following code(s) above M81.0 contain annotation back-references that may be applicable to M81.0:
- M00-M99
- Diseases of the musculoskeletal system and connective tissue
- M81
- Osteoporosis without current pathological fracture
Approximate Synonyms
- Age related osteoporosis
- Osteoporosis
- Osteoporosis (significant thinning of bone)
- Osteoporosis, postmenopausal
- Osteoporosis, senile
- Pathologic osteoporosis
- Postmenopausal osteoporosis
- Senile osteoporosis
Clinical Information
A condition of reduced bone mass, with decreased cortical thickness and a decrease in the number and size of the trabeculae of cancellous bone (but normal chemical composition), resulting in increased fracture incidence. Osteoporosis is classified as primary (type 1, postmenopausal osteoporosis; type 2, age-associated osteoporosis; and idiopathic, which can affect juveniles, premenopausal women, and middle-aged men) and secondary osteoporosis (which results from an identifiable cause of bone mass loss).
A condition that is marked by a decrease in bone mass and density, causing bones to become fragile.
A disorder characterized by reduced bone mass, with a decrease in cortical thickness and in the number and size of the trabeculae of cancellous bone (but normal chemical composition), resulting in increased fracture incidence.
Loss of bone mass and strength due to nutritional, metabolic, or other factors, usually resulting in deformity or fracture; a major public health problem of the elderly, especially women.
Metabolic disorder associated with fractures of the femoral neck, vertebrae, and distal forearm. It occurs commonly in women within 15-20 years after menopause and is caused by factors associated with menopause including estrogen deficiency.
Osteoporosis makes your bones weak and more likely to break. Anyone can develop osteoporosis, but it is common in older women. As many as half of all women and a quarter of men older than 50 will break a bone due to osteoporosis. Risk factors include
- getting older
- being small and thin
- having a family history of osteoporosis
- taking certain medicines
- being a white or Asian woman
- having osteopenia, which is low bone density
Osteoporosis is a silent disease. You might not know you have it until you break a bone. A bone mineral density test is the best way to check your bone health. To keep bones strong, eat a diet rich in calcium and vitamin d, exercise and do not smoke. If needed, medicines can also help. NIH: national institute of arthritis and musculoskeletal and skin diseases
Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis (osteoporosis, postmenopausal) and age-related or senile osteoporosis.
ICD-10-CM M81.0 is grouped within Diagnostic Related Group(s) (MS-DRG v40.0):
- Bone diseases and arthropathies with mcc
- Bone diseases and arthropathies without mcc
Convert M81.0 to ICD-9-CM Code History
- 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
- 2017 (effective 10/1/2016): No change
- 2018 (effective 10/1/2017): No change
- 2019 (effective 10/1/2018): No change
- 2020 (effective 10/1/2019): No change
- 2021 (effective 10/1/2020): No change
- 2022 (effective 10/1/2021): No change
- 2023 (effective 10/1/2022): No change
Top 10 ICD-10 codes for osteoporosis by total diagnoses
| Rank | ICD-10 code | ICD-10 description | # total diagnoses | % total diagnoses |
| 1 | M810 | Age-related osteoporosis without current pathological fracture | 6,861,904 | 74.10% |
| 2 | Z13820 | Encounter for screening for osteoporosis | 1,334,154 | 14.40% |
| 3 | M818 | Other osteoporosis without current pathological fracture | 411,180 | 4.40% |
| 4 | M8008XA | Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture | 69,651 | 0.80% |
| 5 | M8008XD | Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing | 65,757 | 0.70% |
| 6 | Z8262 | Family history of osteoporosis | 53,753 | 0.60% |
| 7 | M816 | Localized osteoporosis [Lequesne] | 53,060 | 0.60% |
| 8 | M8000XD | Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with routine healing | 51,836 | 0.60% |
| 9 | M8000XA | Age-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture | 47,833 | 0.50% |
| 10 | M80052D | Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing | 31,000 | 0.30% |
Diagnostic Criteria for Osteoporosis:
To assign the appropriate ICD-10 code for osteoporosis, healthcare providers must rely on established diagnostic criteria. The World Health Organization (WHO) defines osteoporosis based on bone mineral density (BMD) measurements. According to the WHO criteria, a T-score of -2.5 or lower signifies osteoporosis. The T-score compares an individual’s BMD to the peak BMD of a healthy young adult. This criterion aids clinicians in accurately diagnosing and coding osteoporosis cases using the ICD-10 system.
Role of Fracture Risk Assessment Tool (FRAX)
In addition to BMD measurements, the Fracture Risk Assessment Tool (FRAX) is a valuable resource for estimating an individual’s 10-year probability of major osteoporotic fractures. By considering clinical risk factors such as age, gender, previous fractures, and more, FRAX enhances the accuracy of osteoporosis risk assessment. Aligning with ICD-10 coding practices, healthcare professionals can better stratify patients’ fracture risks and implement timely interventions.
Treatment and Management of Osteoporosis:
Effectively managing osteoporosis necessitates a multidisciplinary approach. ICD-10 codes play a pivotal role in facilitating collaboration among various healthcare providers, including primary care physicians, endocrinologists, orthopedic surgeons, and physical therapists. Accurate coding enables seamless communication and coordination, ensuring patients receive comprehensive care tailored to their specific needs.
Pharmaceutical Interventions and ICD-10 Coding
Pharmacological interventions are a cornerstone of osteoporosis management. Anti-resorptive medications, such as bisphosphonates (“M05”), hormone replacement therapy (“N95.0”), and monoclonal antibodies (“Z51.89”) are commonly prescribed to enhance bone density and reduce fracture risk. The integration of ICD-10 codes with prescription practices facilitates efficient medication management, tracking, and billing procedures.
Importance of Accurate ICD-10 Coding:
Ensuring Precision in Healthcare Records
Accurate ICD-10 coding is not merely a bureaucratic requirement; it significantly impacts patient care and outcomes. Proper coding aids healthcare providers in understanding the patient’s medical history, making informed treatment decisions, and monitoring disease progression. By using the appropriate ICD-10 codes, healthcare professionals contribute to an ecosystem of accurate data, enabling evidence-based practices and improved patient management.
Facilitating Research and Epidemiological Studies
ICD-10 codes have a profound impact on epidemiological studies that examine the prevalence, incidence, and risk factors associated with osteoporosis. Researchers rely on these codes to identify patient populations, analyze trends, and develop preventive strategies. The consistency and accuracy of ICD-10 coding directly influences the quality and reliability of research outcomes in the field of osteoporosis.
Conclusion:
In the world of modern healthcare, precision and accuracy are essential elements that drive effective patient care, research endeavors, and health policy decisions. Osteoporosis, a condition with far-reaching consequences, finds its place in the ICD-10 coding framework, which offers a comprehensive system for classifying, documenting, and managing the disease. The appropriate application of ICD-10 codes ensures that healthcare professionals across disciplines can collaborate seamlessly, leading to optimal patient outcomes and contributing to the advancement of osteoporosis research and treatment strategies. As the healthcare landscape continues to evolve, the role of ICD-10 codes in osteoporosis management remains indispensable.
