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2025 ICD-10-CM code M80.0

Age-related osteoporosis with current pathological fracture.

Use additional codes to identify the specific site of the fracture (e.g., hip, vertebra, wrist).Seventh characters are used to specify the episode of care related to the fracture (initial encounter, subsequent encounter with routine healing, etc.)

Medical necessity is established by the presence of a fracture caused by osteoporosis.The documentation should support the diagnosis and treatment plan.

Diagnosis involves patient history, physical exam (range of motion, muscle strength), imaging (X-rays, MRI, CT, DEXA scans), and lab tests (ESR). Treatment includes pain medication, bracing/splinting, dietary changes, calcium supplements, lifestyle modifications (e.g., quitting smoking), exercise, surgery for the fracture, and treating the underlying osteoporosis.

In simple words: This means a bone has broken because it was weakened by age-related osteoporosis.This type of break happens even without a major injury.

This code signifies a current pathological fracture due to age-related osteoporosis.A pathological fracture occurs when a bone breaks due to weakness caused by a disease, rather than from significant trauma.

Example 1: A 70-year-old female falls from standing height and fractures her hip.DEXA scan confirms osteoporosis., An 80-year-old male with known osteoporosis experiences sudden back pain after bending over.X-rays reveal a vertebral compression fracture., A 75-year-old female with a history of osteoporosis develops wrist pain after a minor fall.Diagnosis reveals a distal radius fracture.

Documentation should include the type of fracture, location, laterality, presence or absence of a fracture, episode of care (initial or subsequent), and supporting clinical findings like imaging and lab results.

** For proper coding, it's crucial to differentiate a pathological fracture due to osteoporosis from a fracture caused primarily by trauma.The underlying osteoporosis is the key factor making this a pathological fracture.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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