ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 M80.861K

Billable / Specific CC

Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion

M80
Block
0
Synonyms
85
LCDs
11
Payer Policies
0
Linked CPTs

About ICD-10-CM M80.861K

ICD-10-CM code M80.861K represents Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M80). The 2026 edition of ICD-10-CM M80.861K became effective on October 1, 2025.

Coding Tips for M80.861K

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

Inpatient DRG impact: CC

M80.861K is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.

Inpatient DRG Impact, CC

codes Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.

Medicare LCD Coverage for M80.861K

Local Coverage Determinations (LCDs) from CMS MACs that list M80.861K as a covered diagnosis.

85 LCDs

Showing top 10 of 85 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Vitamin D Assay Testing
Article ID: 57736, Effective: 2024-10-01 00:00:00, 553 covered, 0 non-covered
CPT 82652 →
CMS LCD: Billing and Coding: Vitamin D Assay Testing
Article ID: 57736, Effective: 2024-10-01 00:00:00, 553 covered, 0 non-covered
CPT 82306 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27134 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27130 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27487 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27137 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27486 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27138 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27132 →
CMS LCD: Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Article ID: 56796, Effective: 2026-01-01 00:00:00, 1355 covered, 1 non-covered
CPT 27447 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M80.861K.

11 policies

5 Medicare

Billing and Coding: Denosumab (Prolia�, Xgeva�, Jubbonti�, Wyost�, Ospomyv�,Xbryk�,Bomyntra�, Conexxence�, Stoboclo�, Osenvelt�,Bildyos�, Bilprevda�)
Policy ID: ART-52399
Billing and Coding: Ibandronate Sodium
Policy ID: ART-52421
Knee Orthoses - Policy Article
Policy ID: ART-52465
Billing and Coding: Assays for Vitamins and Metabolic Function
Policy ID: ART-56416
Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)
Policy ID: ART-56796

CPT Codes Commonly Billed with M80.861K

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for M80.861K

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert M80.861K to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
M80.861K 73382 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 M80.861K, Billing FAQ

Is ICD-10 code M80.861K billable? +

Yes, M80.861K is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

Is M80.861K a CC or MCC for inpatient DRG? +

Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.

What ICD-9 codes does M80.861K map to? +

Per CMS GEMs, M80.861K maps to ICD-9 codes: 73382. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 1, 2026.

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