M80.811D

ICD-10-CM Official Guidelines for Coding and Reporting, quoted in full. Published by CMS and NCHS; in the public domain.

I.C.13 Chapter 13: Diseases of the Musculoskeletal System and Connective names this code p.60

Tissue (M00-M99)

I.C.13.a.1 Bone versus joint names this code p.60

For certain conditions, the bone may be affected at the upper or lower end, (e.g., avascular necrosis of bone, M87, Osteoporosis, M80, M81). Though the portion of the bone affected may be at the joint, the site designation will be the bone, not the joint.

I.C.13.d Osteoporosis names this code p.61

Osteoporosis is a systemic condition, meaning that all bones of the musculoskeletal system are affected. Therefore, site is not a component of the codes under category M81, Osteoporosis without current pathological fracture. The site codes under category M80, Osteoporosis with current pathological fracture, identify the site of the fracture, not the osteoporosis.

I.C.13.d.2 Osteoporosis with current pathological fracture names this code p.62

Category M80, Osteoporosis with current pathological fracture, is for patients who have a current pathologic fracture at the time of an encounter. The codes under M80 identify the site of the fracture. A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.

I.C.19.c.1 Initial vs. subsequent encounter for fractures names this code p.79

Traumatic fractures are coded using the appropriate 7 character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. The appropriate 7 character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion. Fractures are coded using the appropriate 7 character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes. Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7 character for subsequent care with nonunion (K, M, N,) or subsequent care with malunion (P, Q, R). Malunion/nonunion: The appropriate 7 character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion. The open fracture designations in the assignment of the 7th character for fractures of the forearm, femur and lower leg, including ankle are based on the Gustilo open fracture classification. When the Gustilo classification type is not specified for an open fracture, the 7th character for open fracture type I or II should be assigned (B, E, H, M, Q). A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone. See Section I.C.13. Osteoporosis. The aftercare Z codes should not be used for aftercare for traumatic fractures. For aftercare of a traumatic fracture, assign the acute fracture code with the appropriate 7 character.

I.C.13.a Site and laterality chapter guidance p.60

Most of the codes within Chapter 13 have site and laterality designations. The site represents the bone, joint or the muscle involved.

I.C.13.a.2 Multiple sites chapter guidance p.61

Codes describing specified sites are assigned individually by site when documented. When the specified site(s) are not documented, assign the appropriate code for “multiple sites.”

I.C.13.b Acute traumatic versus chronic or recurrent musculoskeletal chapter guidance p.61

conditions Many musculoskeletal conditions are a result of previous injury or trauma to a site, or are recurrent conditions. Bone, joint or muscle conditions that are the result of a healed injury are usually found in chapter 13. Recurrent bone, joint or muscle conditions are also usually found in chapter 13. Any current, acute injury should be coded to the appropriate injury code from chapter 19. Chronic or recurrent conditions should generally be coded with a code from chapter 13. If it is difficult to determine from the documentation in the record which code is best to describe a condition, query the provider.

I.C.13.c Coding of Pathologic Fractures chapter guidance p.61

7 character A is for use as long as the patient is receiving active treatment for the fracture. While the patient may be seen by a new or different provider over the course of treatment for a pathological fracture, assignment of the 7 character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time. 7th character D is to be used for encounters after the patient has completed active treatment for the fracture and is receiving routine care for the fracture during the healing or recovery phase. The other 7 characters, listed under each subcategory in the Tabular List, are to be used for subsequent encounters for treatment of problems associated with the healing, such as malunions, nonunions, and sequelae. Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes. See Section I.C.19. Coding of traumatic fractures.

I.C.13.d.1 Osteoporosis without pathological fracture chapter guidance p.62

Category M81, Osteoporosis without current pathological fracture, is for use for patients with osteoporosis who do not currently have a pathologic fracture due to the osteoporosis, even if they have had a fracture in the past. For patients with a history of osteoporosis fractures, status code Z87.310, Personal history of (healed) osteoporosis fracture, should follow the code from M81.

I.C.13.e Multisystem Inflammatory Syndrome chapter guidance p.62

See Section I.C.1.g.1.l. for Multisystem Inflammatory Syndrome

Risk adjustment

This code