Coding Spotlight Osteoporosis

Every month, Global Healthcare Resource's General Manager of Coding Quality, Viba Raghavendran (CPC) and Deputy General Manager of Coding Operations Sivashankari Thangavelu (CPC,BCHHC,RCC & CCS) share helpful rule reminders and coding  information for specific medical conditions. This month, Viba and Sivashankari dive into Osteoporosis and its many classifications.

Osteoporosis Summary:

Osteoporosis or porous bone is a systemic condition affecting all bones of the musculoskeletal system. Osteoporosis occurs when too little bone is made, or too much bone is lost. Human bones are constantly being remodeled. This process occurs more rapidly in childhood and young adulthood. Over time, the rate of breaking down old bone surpasses the rate of new bone growth. This loss in bone mass or density may cause the bone to become porous, brittle, weak, and more easily broken.

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Bone Density Measurement (BDM) testing is used to determine the amount of bone loss present. A patient’s current BDM is compared to the BDM at age 30. The difference is then calculated to determine if the patient’s T-score. Depending upon the T-score, a patient may have osteopenia (low bone mass) or osteoporosis (very low bone mass).

Osteoporosis Classifications:

 M81.0: Age related osteoporosis with current pathological fracture:

• Involutional osteoporosis
• Postmenopausal osteoporosis
• Senile osteoporosis
• Osteoporosis NOS

M80: Other osteoporosis with current pathological fracture (8 subsets):

• Drug induced osteoporosis
• Idiopathic osteoporosis
• Osteoporosis of disuse
• Post-oophorectomy osteoporosis
• Post-surgical malabsorption osteoporosis
• Post-traumatic osteoporosis

M82: Osteoporosis in diseases classified elsewhere like endocrine disorders and myelomatosis.

M81: Osteoporosis without current pathological fracture (9 subsets) 
codes relate to osteoporosis without a pathological fracture: 9 subsets
If the patient does not have current pathological fracture, you should select a code from the M81 series (even if the patient had pathological fracture in the past).

Selecting a Diagnosis Code for Osteoporosis

A sixth digit indicates laterality, EX: 

• M80.811 Other osteoporosis with current pathological fracture, right shoulder
• M80.812 Other osteoporosis with current pathological fracture, left shoulder
• M80.819 Other osteoporosis with current pathological fracture, unspecified shoulder

Additionally, a seventh digit indicates the episode of care, as follows:

• A: initial encounter for fracture
• D: Initial encounter for fracture routine healing
• G: subsequent encounter for fracture delayed healing
• K: subsequent encounter for fracture with nonunion
• P: subsequent encounter for fracture for malunion
• S: sequela

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