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ICD-10-CM M80.859A: Other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture

M80.859A is the billable ICD-10-CM code for other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture, in category M80 (Osteoporosis with current pathological fracture) of the Disorders of bone density and structure section. As a principal diagnosis it groups to MS-DRG 521 Hip Replacement with Principal Diagnosis of Hip Fracture with MCC, MS-DRG 522 Hip Replacement with Principal Diagnosis of Hip Fracture without MCC, MS-DRG 542 Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with MCC (MDC 08 MDC 08: Diseases and Disorders of the Musculoskeletal System and Connective Tissue); or MS-DRG 791 Prematurity with Major Problems, MS-DRG 793 Full Term Neonate with Major Problems (MDC 15 MDC 15: Newborns and Other Neonates with Conditions Originating in Perinatal Period). It maps to HCC 402 (Hip Fracture/Dislocation) in CMS-HCC V28. As a secondary diagnosis it is a CC, excluded with 214 principal diagnoses. 5 LCD billing and coding articles list it as covered.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM code descriptions: FY2027 (effective October 1, 2026); IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: FY2028 code files, effective October 1, 2027 for the ICD-10-CM code descriptions; FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027) for the ICD-10-CM to HCC mapping; weekly, every Thursday for the Medicare Coverage Database billing and coding articles.

Code
M80.859A
billable FY2027 ICD-10-CM code
Category
M80 Osteoporosis with current pathological fracture
Chapter
13: Diseases of the musculoskeletal system and connective tissue (M00-M99)
CC/MCC (MS-DRG v44)
CC
CMS-HCC V28
HCC 402
POA reporting
Required

Tabular list notes for M80.859A

The tabular list has no notes on M80.859A itself; the notes below apply from its parent headings.

Inherited from M80 (Osteoporosis with current pathological fracture)

Includes
  • osteoporosis with current fragility fracture
Excludes1 (never coded together)
  • collapsed vertebra NOS (M48.5)
  • pathological fracture NOS (M84.4)
  • wedging of vertebra NOS (M48.5)
Excludes2 (not part of this condition, may be coded together)
  • personal history of (healed) osteoporosis fracture (Z87.310)
Use additional code
  • code to identify major osseous defect, if applicable (M89.7-)

Inherited from M80.8 (Other osteoporosis with current pathological fracture)

Inclusion terms
  • Drug-induced osteoporosis with current pathological fracture
  • Idiopathic osteoporosis with current pathological fracture
  • Osteoporosis of disuse with current pathological fracture
  • Postoophorectomy osteoporosis with current pathological fracture
  • Postsurgical malabsorption osteoporosis with current pathological fracture
  • Post-traumatic osteoporosis with current pathological fracture
Use additional code
  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Inherited from M80.85 (Other osteoporosis with current pathological fracture, femur)

Inclusion terms
  • Other osteoporosis with current pathological fracture of hip

The 7th character A means “initial encounter for fracture”, as defined at M80. The same injury coded for a later encounter uses a different 7th character, so check each encounter.

MS-DRG grouping when M80.859A is the principal diagnosis

MS-DRG v44 groups for M80.859A as principal diagnosis
MDCMS-DRGs
08 MDC 08: Diseases and Disorders of the Musculoskeletal System and Connective Tissue521522542543544
15 MDC 15: Newborns and Other Neonates with Conditions Originating in Perinatal Period791793

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for M80.859A shows the full grouping logic.

CC/MCC status and inpatient edits

As a secondary diagnosis, M80.859A is a CC under MS-DRG v44, unless the principal diagnosis is one of the 214 codes in its exclusion list. Check M80.859A against a principal diagnosis.

  • Present on admission: a POA indicator is required on inpatient claims.
  • Medicare Code Editor: unspecified code where a laterality-specific code exists.

CMS-HCC V28 risk adjustment

In the PY2027 mapping, M80.859A maps to HCC 402 (Hip Fracture/Dislocation). The HCC lookup shows the RAF weight and the hierarchy.

LCD billing and coding articles that list M80.859A

5 current Medicare billing and coding articles list M80.859A among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM M80.859A mean?

M80.859A means other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture. It is one of 25 billable codes under M80, osteoporosis with current pathological fracture.

Which MS-DRG does M80.859A group to?

As the principal diagnosis, M80.859A groups to MS-DRG 521 Hip Replacement with Principal Diagnosis of Hip Fracture with MCC, MS-DRG 522 Hip Replacement with Principal Diagnosis of Hip Fracture without MCC, MS-DRG 542 Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with MCC (MDC 08 MDC 08: Diseases and Disorders of the Musculoskeletal System and Connective Tissue); or MS-DRG 791 Prematurity with Major Problems, MS-DRG 793 Full Term Neonate with Major Problems (MDC 15 MDC 15: Newborns and Other Neonates with Conditions Originating in Perinatal Period) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Does M80.859A map to an HCC?

Yes: HCC 402, Hip Fracture/Dislocation, in the PY2027 CMS-HCC V28 mapping.

Is M80.859A a CC or MCC?

M80.859A is a CC under MS-DRG v44; 214 principal diagnoses exclude it.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The descriptor and notes are reproduced from the FY2027 ICD-10-CM files; MS-DRG, CC/MCC and HCC facts come from the CMS FY2027 and PY2027 tables. Code from the medical record and the ICD-10-CM Official Guidelines. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.