RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications

A57603

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Source Article ID
N/A
Article ID
A57603
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications
Article Type
Billing and Coding
Original Effective Date
10/15/2019
Revision Effective Date
10/01/2023
Revision Ending Date
12/14/2023
Retirement Date
12/14/2023

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  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33270 Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.

3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

4. For Intravenous bisphosphonate therapy, the documentation should include the following information:

  • Criteria for the diagnosis of osteoporosis, and
  • History of treatment as related to progression of disease and ongoing risk factors, and
  • Description of treatment failure of oral or self-administered drugs for osteoporosis as applicable to the patient that supports IV therapy in lieu of standard oral treatment protocol.
  • An indication that the serum creatinine was measured prior to the administration of the drug.
  • An indication that the oral health of the patient was discussed

5. For monoclonal antibodies – RANK ligand (RANKL) inhibitors therapy, the documentation should include the following information:

  • Criteria for the diagnosis of osteoporosis, and
  • History of treatment as related to progression of disease and ongoing risk factors, and
  • Description of treatment failure, or contraindication, or adverse side effects of oral or self-administered drugs for osteoporosis as applicable to the patient that supports monoclonal antibodies via SQ injection therapy in lieu of standard oral treatment protocol.

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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(343 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for HCPCS code: J0897 (Prolia®).

Group 1 Codes
Code Description
M80.00XA Age-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
M80.00XD Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with routine healing
M80.00XG Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with delayed healing
M80.00XK Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with nonunion
M80.00XP Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with malunion
M80.00XS Age-related osteoporosis with current pathological fracture, unspecified site, sequela
M80.011A Age-related osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
M80.011D Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing
M80.011G Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing
M80.011K Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion
M80.011P Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion
M80.011S Age-related osteoporosis with current pathological fracture, right shoulder, sequela
M80.012A Age-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture
M80.012D Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing
M80.012G Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing
M80.012K Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion
M80.012P Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion
M80.012S Age-related osteoporosis with current pathological fracture, left shoulder, sequela
M80.019A Age-related osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture
M80.019D Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with routine healing
M80.019G Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing
M80.019K Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with nonunion
M80.019P Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with malunion
M80.019S Age-related osteoporosis with current pathological fracture, unspecified shoulder, sequela
M80.021A Age-related osteoporosis with current pathological fracture, right humerus, initial encounter for fracture
M80.021D Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing
M80.021G Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with delayed healing
M80.021K Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with nonunion
M80.021P Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with malunion
M80.021S Age-related osteoporosis with current pathological fracture, right humerus, sequela
M80.022A Age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture
M80.022D Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with routine healing
M80.022G Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with delayed healing
M80.022K Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with nonunion
M80.022P Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with malunion
M80.022S Age-related osteoporosis with current pathological fracture, left humerus, sequela
M80.029A Age-related osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture
M80.029D Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with routine healing
M80.029G Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with delayed healing
M80.029K Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with nonunion
M80.029P Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with malunion
M80.029S Age-related osteoporosis with current pathological fracture, unspecified humerus, sequela
M80.031A Age-related osteoporosis with current pathological fracture, right forearm, initial encounter for fracture
M80.031D Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with routine healing
M80.031G Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with delayed healing
M80.031K Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with nonunion
M80.031P Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with malunion
M80.031S Age-related osteoporosis with current pathological fracture, right forearm, sequela
M80.032A Age-related osteoporosis with current pathological fracture, left forearm, initial encounter for fracture
M80.032D Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing
M80.032G Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with delayed healing
M80.032K Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with nonunion
M80.032P Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with malunion
M80.032S Age-related osteoporosis with current pathological fracture, left forearm, sequela
M80.039A Age-related osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture
M80.039D Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with routine healing
M80.039G Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with delayed healing
M80.039K Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with nonunion
M80.039P Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with malunion
M80.039S Age-related osteoporosis with current pathological fracture, unspecified forearm, sequela
M80.041A Age-related osteoporosis with current pathological fracture, right hand, initial encounter for fracture
M80.041D Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing
M80.041G Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with delayed healing
M80.041K Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with nonunion
M80.041P Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with malunion
M80.041S Age-related osteoporosis with current pathological fracture, right hand, sequela
M80.042A Age-related osteoporosis with current pathological fracture, left hand, initial encounter for fracture
M80.042D Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with routine healing
M80.042G Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with delayed healing
M80.042K Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with nonunion
M80.042P Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with malunion
M80.042S Age-related osteoporosis with current pathological fracture, left hand, sequela
M80.049A Age-related osteoporosis with current pathological fracture, unspecified hand, initial encounter for fracture
M80.049D Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with routine healing
M80.049G Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with delayed healing
M80.049K Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with nonunion
M80.049P Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with malunion
M80.049S Age-related osteoporosis with current pathological fracture, unspecified hand, sequela
M80.051A Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture
M80.051D Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing
M80.051G Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing
M80.051K Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion
M80.051P Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion
M80.051S Age-related osteoporosis with current pathological fracture, right femur, sequela
M80.052A Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture
M80.052D Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing
M80.052G Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing
M80.052K Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion
M80.052P Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion
M80.052S Age-related osteoporosis with current pathological fracture, left femur, sequela
M80.059A Age-related osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture
M80.059D Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with routine healing
M80.059G Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with delayed healing
M80.059K Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with nonunion
M80.059P Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with malunion
M80.059S Age-related osteoporosis with current pathological fracture, unspecified femur, sequela
M80.061A Age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture
M80.061D Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing
M80.061G Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with delayed healing
M80.061K Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion
M80.061P Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with malunion
M80.061S Age-related osteoporosis with current pathological fracture, right lower leg, sequela
M80.062A Age-related osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture
M80.062D Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with routine healing
M80.062G Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with delayed healing
M80.062K Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with nonunion
M80.062P Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with malunion
M80.062S Age-related osteoporosis with current pathological fracture, left lower leg, sequela
M80.069A Age-related osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture
M80.069D Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with routine healing
M80.069G Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with delayed healing
M80.069K Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with nonunion
M80.069P Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with malunion
M80.069S Age-related osteoporosis with current pathological fracture, unspecified lower leg, sequela
M80.071A Age-related osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture
M80.071D Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with routine healing
M80.071G Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with delayed healing
M80.071K Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with nonunion
M80.071P Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with malunion
M80.071S Age-related osteoporosis with current pathological fracture, right ankle and foot, sequela
M80.072A Age-related osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture
M80.072D Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with routine healing
M80.072G Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing
M80.072K Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with nonunion
M80.072P Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with malunion
M80.072S Age-related osteoporosis with current pathological fracture, left ankle and foot, sequela
M80.079A Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture
M80.079D Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with routine healing
M80.079G Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with delayed healing
M80.079K Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with nonunion
M80.079P Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with malunion
M80.079S Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, sequela
M80.08XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.08XD Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing
M80.08XG Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing
M80.08XK Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion
M80.08XP Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion
M80.08XS Age-related osteoporosis with current pathological fracture, vertebra(e), sequela
M80.0AXA Age-related osteoporosis with current pathological fracture, other site, initial encounter for fracture
M80.0AXD Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing
M80.0AXG Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing
M80.0AXK Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion
M80.0AXP Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion
M80.0AXS Age-related osteoporosis with current pathological fracture, other site, sequela
M80.0B1A Age-related osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
M80.0B1D Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing
M80.0B1G Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing
M80.0B1K Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion
M80.0B1P Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion
M80.0B1S Age-related osteoporosis with current pathological fracture, right pelvis, sequela
M80.0B2A Age-related osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture
M80.0B2D Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing
M80.0B2G Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing
M80.0B2K Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion
M80.0B2P Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion
M80.0B2S Age-related osteoporosis with current pathological fracture, left pelvis, sequela
M80.80XA Other osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
M80.80XD Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with routine healing
M80.80XG Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with delayed healing
M80.80XK Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with nonunion
M80.80XP Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with malunion
M80.80XS Other osteoporosis with current pathological fracture, unspecified site, sequela
M80.811A Other osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
M80.811D Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing
M80.811G Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing
M80.811K Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion
M80.811P Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion
M80.811S Other osteoporosis with current pathological fracture, right shoulder, sequela
M80.812A Other osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture
M80.812D Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing
M80.812G Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing
M80.812K Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion
M80.812P Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion
M80.812S Other osteoporosis with current pathological fracture, left shoulder, sequela
M80.819A Other osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture
M80.819D Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with routine healing
M80.819G Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing
M80.819K Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with nonunion
M80.819P Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with malunion
M80.819S Other osteoporosis with current pathological fracture, unspecified shoulder, sequela
M80.821A Other osteoporosis with current pathological fracture, right humerus, initial encounter for fracture
M80.821D Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing
M80.821G Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with delayed healing
M80.821K Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with nonunion
M80.821P Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with malunion
M80.821S Other osteoporosis with current pathological fracture, right humerus, sequela
M80.822A Other osteoporosis with current pathological fracture, left humerus, initial encounter for fracture
M80.822D Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with routine healing
M80.822G Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with delayed healing
M80.822K Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with nonunion
M80.822P Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with malunion
M80.822S Other osteoporosis with current pathological fracture, left humerus, sequela
M80.829A Other osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture
M80.829D Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with routine healing
M80.829G Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with delayed healing
M80.829K Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with nonunion
M80.829P Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with malunion
M80.829S Other osteoporosis with current pathological fracture, unspecified humerus, sequela
M80.831A Other osteoporosis with current pathological fracture, right forearm, initial encounter for fracture
M80.831D Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with routine healing
M80.831G Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with delayed healing
M80.831K Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with nonunion
M80.831P Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with malunion
M80.831S Other osteoporosis with current pathological fracture, right forearm, sequela
M80.832A Other osteoporosis with current pathological fracture, left forearm, initial encounter for fracture
M80.832D Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing
M80.832G Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with delayed healing
M80.832K Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with nonunion
M80.832P Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with malunion
M80.832S Other osteoporosis with current pathological fracture, left forearm, sequela
M80.839A Other osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture
M80.839D Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with routine healing
M80.839G Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with delayed healing
M80.839K Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with nonunion
M80.839P Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with malunion
M80.839S Other osteoporosis with current pathological fracture, unspecified forearm, sequela
M80.841A Other osteoporosis with current pathological fracture, right hand, initial encounter for fracture
M80.841D Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing
M80.841G Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with delayed healing
M80.841K Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with nonunion
M80.841P Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with malunion
M80.841S Other osteoporosis with current pathological fracture, right hand, sequela
M80.842A Other osteoporosis with current pathological fracture, left hand, initial encounter for fracture
M80.842D Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with routine healing
M80.842G Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with delayed healing
M80.842K Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with nonunion
M80.842P Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with malunion
M80.842S Other osteoporosis with current pathological fracture, left hand, sequela
M80.849A Other osteoporosis with current pathological fracture, unspecified hand, initial encounter for fracture
M80.849D Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with routine healing
M80.849G Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with delayed healing
M80.849K Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with nonunion
M80.849P Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with malunion
M80.849S Other osteoporosis with current pathological fracture, unspecified hand, sequela
M80.851A Other osteoporosis with current pathological fracture, right femur, initial encounter for fracture
M80.851D Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing
M80.851G Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing
M80.851K Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion
M80.851P Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion
M80.851S Other osteoporosis with current pathological fracture, right femur, sequela
M80.852A Other osteoporosis with current pathological fracture, left femur, initial encounter for fracture
M80.852D Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing
M80.852G Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing
M80.852K Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion
M80.852P Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion
M80.852S Other osteoporosis with current pathological fracture, left femur, sequela
M80.859A Other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture
M80.859D Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with routine healing
M80.859G Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with delayed healing
M80.859K Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with nonunion
M80.859P Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with malunion
M80.859S Other osteoporosis with current pathological fracture, unspecified femur, sequela
M80.861A Other osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture
M80.861D Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing
M80.861G Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with delayed healing
M80.861K Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion
M80.861P Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with malunion
M80.861S Other osteoporosis with current pathological fracture, right lower leg, sequela
M80.862A Other osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture
M80.862D Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with routine healing
M80.862G Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with delayed healing
M80.862K Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with nonunion
M80.862P Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with malunion
M80.862S Other osteoporosis with current pathological fracture, left lower leg, sequela
M80.869A Other osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture
M80.869D Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with routine healing
M80.869G Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with delayed healing
M80.869K Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with nonunion
M80.869P Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with malunion
M80.869S Other osteoporosis with current pathological fracture, unspecified lower leg, sequela
M80.871A Other osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture
M80.871D Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with routine healing
M80.871G Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with delayed healing
M80.871K Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with nonunion
M80.871P Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with malunion
M80.871S Other osteoporosis with current pathological fracture, right ankle and foot, sequela
M80.872A Other osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture
M80.872D Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with routine healing
M80.872G Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing
M80.872K Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with nonunion
M80.872P Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with malunion
M80.872S Other osteoporosis with current pathological fracture, left ankle and foot, sequela
M80.879A Other osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture
M80.879D Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with routine healing
M80.879G Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with delayed healing
M80.879K Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with nonunion
M80.879P Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with malunion
M80.879S Other osteoporosis with current pathological fracture, unspecified ankle and foot, sequela
M80.88XA Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.88XD Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing
M80.88XG Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing
M80.88XK Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion
M80.88XP Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion
M80.88XS Other osteoporosis with current pathological fracture, vertebra(e), sequela
M80.8AXA Other osteoporosis with current pathological fracture, other site, initial encounter for fracture
M80.8AXD Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing
M80.8AXG Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing
M80.8AXK Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion
M80.8AXP Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion
M80.8AXS Other osteoporosis with current pathological fracture, other site, sequela
M80.8B1A Other osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
M80.8B1D Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing
M80.8B1G Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing
M80.8B1K Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion
M80.8B1P Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion
M80.8B1S Other osteoporosis with current pathological fracture, right pelvis, sequela
M80.8B2A Other osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture
M80.8B2D Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing
M80.8B2G Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing
M80.8B2K Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion
M80.8B2P Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion
M80.8B2S Other osteoporosis with current pathological fracture, left pelvis, sequela
M81.0 Age-related osteoporosis without current pathological fracture
M81.6 Localized osteoporosis [Lequesne]
M81.8 Other osteoporosis without current pathological fracture
M85.80 Other specified disorders of bone density and structure, unspecified site
M85.811 Other specified disorders of bone density and structure, right shoulder
M85.812 Other specified disorders of bone density and structure, left shoulder
M85.819 Other specified disorders of bone density and structure, unspecified shoulder
M85.821 Other specified disorders of bone density and structure, right upper arm
M85.822 Other specified disorders of bone density and structure, left upper arm
M85.829 Other specified disorders of bone density and structure, unspecified upper arm
M85.831 Other specified disorders of bone density and structure, right forearm
M85.832 Other specified disorders of bone density and structure, left forearm
M85.839 Other specified disorders of bone density and structure, unspecified forearm
M85.841 Other specified disorders of bone density and structure, right hand
M85.842 Other specified disorders of bone density and structure, left hand
M85.849 Other specified disorders of bone density and structure, unspecified hand
M85.851 Other specified disorders of bone density and structure, right thigh
M85.852 Other specified disorders of bone density and structure, left thigh
M85.859 Other specified disorders of bone density and structure, unspecified thigh
M85.861 Other specified disorders of bone density and structure, right lower leg
M85.862 Other specified disorders of bone density and structure, left lower leg
M85.869 Other specified disorders of bone density and structure, unspecified lower leg
M85.871 Other specified disorders of bone density and structure, right ankle and foot
M85.872 Other specified disorders of bone density and structure, left ankle and foot
M85.879 Other specified disorders of bone density and structure, unspecified ankle and foot
M85.88 Other specified disorders of bone density and structure, other site
M85.89 Other specified disorders of bone density and structure, multiple sites
M85.9 Disorder of bone density and structure, unspecified
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.0X5D Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter
T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, sequela

Group 2

(199 Codes)
Group 2 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for HCPCS code: J0897 (Xgeva®).

Additional information beyond ICD-10-CM description: E83.52 Hypercalcemia (associated with malignancy)

Group 2 Codes
Code Description
C79.51 Secondary malignant neoplasm of bone
C79.52 Secondary malignant neoplasm of bone marrow
C90.00 Multiple myeloma not having achieved remission
C90.01 Multiple myeloma in remission
C90.02 Multiple myeloma in relapse
D48.0 Neoplasm of uncertain behavior of bone and articular cartilage
E83.52 Hypercalcemia
M84.50XA Pathological fracture in neoplastic disease, unspecified site, initial encounter for fracture
M84.50XD Pathological fracture in neoplastic disease, unspecified site, subsequent encounter for fracture with routine healing
M84.50XG Pathological fracture in neoplastic disease, unspecified site, subsequent encounter for fracture with delayed healing
M84.50XK Pathological fracture in neoplastic disease, unspecified site, subsequent encounter for fracture with nonunion
M84.50XP Pathological fracture in neoplastic disease, unspecified site, subsequent encounter for fracture with malunion
M84.50XS Pathological fracture in neoplastic disease, unspecified site, sequela
M84.511A Pathological fracture in neoplastic disease, right shoulder, initial encounter for fracture
M84.511D Pathological fracture in neoplastic disease, right shoulder, subsequent encounter for fracture with routine healing
M84.511G Pathological fracture in neoplastic disease, right shoulder, subsequent encounter for fracture with delayed healing
M84.511K Pathological fracture in neoplastic disease, right shoulder, subsequent encounter for fracture with nonunion
M84.511P Pathological fracture in neoplastic disease, right shoulder, subsequent encounter for fracture with malunion
M84.511S Pathological fracture in neoplastic disease, right shoulder, sequela
M84.512A Pathological fracture in neoplastic disease, left shoulder, initial encounter for fracture
M84.512D Pathological fracture in neoplastic disease, left shoulder, subsequent encounter for fracture with routine healing
M84.512G Pathological fracture in neoplastic disease, left shoulder, subsequent encounter for fracture with delayed healing
M84.512K Pathological fracture in neoplastic disease, left shoulder, subsequent encounter for fracture with nonunion
M84.512P Pathological fracture in neoplastic disease, left shoulder, subsequent encounter for fracture with malunion
M84.512S Pathological fracture in neoplastic disease, left shoulder, sequela
M84.519A Pathological fracture in neoplastic disease, unspecified shoulder, initial encounter for fracture
M84.519D Pathological fracture in neoplastic disease, unspecified shoulder, subsequent encounter for fracture with routine healing
M84.519G Pathological fracture in neoplastic disease, unspecified shoulder, subsequent encounter for fracture with delayed healing
M84.519K Pathological fracture in neoplastic disease, unspecified shoulder, subsequent encounter for fracture with nonunion
M84.519P Pathological fracture in neoplastic disease, unspecified shoulder, subsequent encounter for fracture with malunion
M84.519S Pathological fracture in neoplastic disease, unspecified shoulder, sequela
M84.521A Pathological fracture in neoplastic disease, right humerus, initial encounter for fracture
M84.521D Pathological fracture in neoplastic disease, right humerus, subsequent encounter for fracture with routine healing
M84.521G Pathological fracture in neoplastic disease, right humerus, subsequent encounter for fracture with delayed healing
M84.521K Pathological fracture in neoplastic disease, right humerus, subsequent encounter for fracture with nonunion
M84.521P Pathological fracture in neoplastic disease, right humerus, subsequent encounter for fracture with malunion
M84.521S Pathological fracture in neoplastic disease, right humerus, sequela
M84.522A Pathological fracture in neoplastic disease, left humerus, initial encounter for fracture
M84.522D Pathological fracture in neoplastic disease, left humerus, subsequent encounter for fracture with routine healing
M84.522G Pathological fracture in neoplastic disease, left humerus, subsequent encounter for fracture with delayed healing
M84.522K Pathological fracture in neoplastic disease, left humerus, subsequent encounter for fracture with nonunion
M84.522P Pathological fracture in neoplastic disease, left humerus, subsequent encounter for fracture with malunion
M84.522S Pathological fracture in neoplastic disease, left humerus, sequela
M84.529A Pathological fracture in neoplastic disease, unspecified humerus, initial encounter for fracture
M84.529D Pathological fracture in neoplastic disease, unspecified humerus, subsequent encounter for fracture with routine healing
M84.529G Pathological fracture in neoplastic disease, unspecified humerus, subsequent encounter for fracture with delayed healing
M84.529K Pathological fracture in neoplastic disease, unspecified humerus, subsequent encounter for fracture with nonunion
M84.529P Pathological fracture in neoplastic disease, unspecified humerus, subsequent encounter for fracture with malunion
M84.529S Pathological fracture in neoplastic disease, unspecified humerus, sequela
M84.531A Pathological fracture in neoplastic disease, right ulna, initial encounter for fracture
M84.531D Pathological fracture in neoplastic disease, right ulna, subsequent encounter for fracture with routine healing
M84.531G Pathological fracture in neoplastic disease, right ulna, subsequent encounter for fracture with delayed healing
M84.531K Pathological fracture in neoplastic disease, right ulna, subsequent encounter for fracture with nonunion
M84.531P Pathological fracture in neoplastic disease, right ulna, subsequent encounter for fracture with malunion
M84.531S Pathological fracture in neoplastic disease, right ulna, sequela
M84.532A Pathological fracture in neoplastic disease, left ulna, initial encounter for fracture
M84.532D Pathological fracture in neoplastic disease, left ulna, subsequent encounter for fracture with routine healing
M84.532G Pathological fracture in neoplastic disease, left ulna, subsequent encounter for fracture with delayed healing
M84.532K Pathological fracture in neoplastic disease, left ulna, subsequent encounter for fracture with nonunion
M84.532P Pathological fracture in neoplastic disease, left ulna, subsequent encounter for fracture with malunion
M84.532S Pathological fracture in neoplastic disease, left ulna, sequela
M84.533A Pathological fracture in neoplastic disease, right radius, initial encounter for fracture
M84.533D Pathological fracture in neoplastic disease, right radius, subsequent encounter for fracture with routine healing
M84.533G Pathological fracture in neoplastic disease, right radius, subsequent encounter for fracture with delayed healing
M84.533K Pathological fracture in neoplastic disease, right radius, subsequent encounter for fracture with nonunion
M84.533P Pathological fracture in neoplastic disease, right radius, subsequent encounter for fracture with malunion
M84.533S Pathological fracture in neoplastic disease, right radius, sequela
M84.534A Pathological fracture in neoplastic disease, left radius, initial encounter for fracture
M84.534D Pathological fracture in neoplastic disease, left radius, subsequent encounter for fracture with routine healing
M84.534G Pathological fracture in neoplastic disease, left radius, subsequent encounter for fracture with delayed healing
M84.534K Pathological fracture in neoplastic disease, left radius, subsequent encounter for fracture with nonunion
M84.534P Pathological fracture in neoplastic disease, left radius, subsequent encounter for fracture with malunion
M84.534S Pathological fracture in neoplastic disease, left radius, sequela
M84.539A Pathological fracture in neoplastic disease, unspecified ulna and radius, initial encounter for fracture
M84.539D Pathological fracture in neoplastic disease, unspecified ulna and radius, subsequent encounter for fracture with routine healing
M84.539G Pathological fracture in neoplastic disease, unspecified ulna and radius, subsequent encounter for fracture with delayed healing
M84.539K Pathological fracture in neoplastic disease, unspecified ulna and radius, subsequent encounter for fracture with nonunion
M84.539P Pathological fracture in neoplastic disease, unspecified ulna and radius, subsequent encounter for fracture with malunion
M84.539S Pathological fracture in neoplastic disease, unspecified ulna and radius, sequela
M84.541A Pathological fracture in neoplastic disease, right hand, initial encounter for fracture
M84.541D Pathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with routine healing
M84.541G Pathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with delayed healing
M84.541K Pathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with nonunion
M84.541P Pathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with malunion
M84.541S Pathological fracture in neoplastic disease, right hand, sequela
M84.542A Pathological fracture in neoplastic disease, left hand, initial encounter for fracture
M84.542D Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with routine healing
M84.542G Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with delayed healing
M84.542K Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with nonunion
M84.542P Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with malunion
M84.542S Pathological fracture in neoplastic disease, left hand, sequela
M84.549A Pathological fracture in neoplastic disease, unspecified hand, initial encounter for fracture
M84.549D Pathological fracture in neoplastic disease, unspecified hand, subsequent encounter for fracture with routine healing
M84.549G Pathological fracture in neoplastic disease, unspecified hand, subsequent encounter for fracture with delayed healing
M84.549K Pathological fracture in neoplastic disease, unspecified hand, subsequent encounter for fracture with nonunion
M84.549P Pathological fracture in neoplastic disease, unspecified hand, subsequent encounter for fracture with malunion
M84.549S Pathological fracture in neoplastic disease, unspecified hand, sequela
M84.550A Pathological fracture in neoplastic disease, pelvis, initial encounter for fracture
M84.550D Pathological fracture in neoplastic disease, pelvis, subsequent encounter for fracture with routine healing
M84.550G Pathological fracture in neoplastic disease, pelvis, subsequent encounter for fracture with delayed healing
M84.550K Pathological fracture in neoplastic disease, pelvis, subsequent encounter for fracture with nonunion
M84.550P Pathological fracture in neoplastic disease, pelvis, subsequent encounter for fracture with malunion
M84.550S Pathological fracture in neoplastic disease, pelvis, sequela
M84.551A Pathological fracture in neoplastic disease, right femur, initial encounter for fracture
M84.551D Pathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with routine healing
M84.551G Pathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with delayed healing
M84.551K Pathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with nonunion
M84.551P Pathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with malunion
M84.551S Pathological fracture in neoplastic disease, right femur, sequela
M84.552A Pathological fracture in neoplastic disease, left femur, initial encounter for fracture
M84.552D Pathological fracture in neoplastic disease, left femur, subsequent encounter for fracture with routine healing
M84.552G Pathological fracture in neoplastic disease, left femur, subsequent encounter for fracture with delayed healing
M84.552K Pathological fracture in neoplastic disease, left femur, subsequent encounter for fracture with nonunion
M84.552P Pathological fracture in neoplastic disease, left femur, subsequent encounter for fracture with malunion
M84.552S Pathological fracture in neoplastic disease, left femur, sequela
M84.553A Pathological fracture in neoplastic disease, unspecified femur, initial encounter for fracture
M84.553D Pathological fracture in neoplastic disease, unspecified femur, subsequent encounter for fracture with routine healing
M84.553G Pathological fracture in neoplastic disease, unspecified femur, subsequent encounter for fracture with delayed healing
M84.553K Pathological fracture in neoplastic disease, unspecified femur, subsequent encounter for fracture with nonunion
M84.553P Pathological fracture in neoplastic disease, unspecified femur, subsequent encounter for fracture with malunion
M84.553S Pathological fracture in neoplastic disease, unspecified femur, sequela
M84.559A Pathological fracture in neoplastic disease, hip, unspecified, initial encounter for fracture
M84.559D Pathological fracture in neoplastic disease, hip, unspecified, subsequent encounter for fracture with routine healing
M84.559G Pathological fracture in neoplastic disease, hip, unspecified, subsequent encounter for fracture with delayed healing
M84.559K Pathological fracture in neoplastic disease, hip, unspecified, subsequent encounter for fracture with nonunion
M84.559P Pathological fracture in neoplastic disease, hip, unspecified, subsequent encounter for fracture with malunion
M84.559S Pathological fracture in neoplastic disease, hip, unspecified, sequela
M84.561A Pathological fracture in neoplastic disease, right tibia, initial encounter for fracture
M84.561D Pathological fracture in neoplastic disease, right tibia, subsequent encounter for fracture with routine healing
M84.561G Pathological fracture in neoplastic disease, right tibia, subsequent encounter for fracture with delayed healing
M84.561K Pathological fracture in neoplastic disease, right tibia, subsequent encounter for fracture with nonunion
M84.561P Pathological fracture in neoplastic disease, right tibia, subsequent encounter for fracture with malunion
M84.561S Pathological fracture in neoplastic disease, right tibia, sequela
M84.562A Pathological fracture in neoplastic disease, left tibia, initial encounter for fracture
M84.562D Pathological fracture in neoplastic disease, left tibia, subsequent encounter for fracture with routine healing
M84.562G Pathological fracture in neoplastic disease, left tibia, subsequent encounter for fracture with delayed healing
M84.562K Pathological fracture in neoplastic disease, left tibia, subsequent encounter for fracture with nonunion
M84.562P Pathological fracture in neoplastic disease, left tibia, subsequent encounter for fracture with malunion
M84.562S Pathological fracture in neoplastic disease, left tibia, sequela
M84.563A Pathological fracture in neoplastic disease, right fibula, initial encounter for fracture
M84.563D Pathological fracture in neoplastic disease, right fibula, subsequent encounter for fracture with routine healing
M84.563G Pathological fracture in neoplastic disease, right fibula, subsequent encounter for fracture with delayed healing
M84.563K Pathological fracture in neoplastic disease, right fibula, subsequent encounter for fracture with nonunion
M84.563P Pathological fracture in neoplastic disease, right fibula, subsequent encounter for fracture with malunion
M84.563S Pathological fracture in neoplastic disease, right fibula, sequela
M84.564A Pathological fracture in neoplastic disease, left fibula, initial encounter for fracture
M84.564D Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with routine healing
M84.564G Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with delayed healing
M84.564K Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with nonunion
M84.564P Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with malunion
M84.564S Pathological fracture in neoplastic disease, left fibula, sequela
M84.569A Pathological fracture in neoplastic disease, unspecified tibia and fibula, initial encounter for fracture
M84.569D Pathological fracture in neoplastic disease, unspecified tibia and fibula, subsequent encounter for fracture with routine healing
M84.569G Pathological fracture in neoplastic disease, unspecified tibia and fibula, subsequent encounter for fracture with delayed healing
M84.569K Pathological fracture in neoplastic disease, unspecified tibia and fibula, subsequent encounter for fracture with nonunion
M84.569P Pathological fracture in neoplastic disease, unspecified tibia and fibula, subsequent encounter for fracture with malunion
M84.569S Pathological fracture in neoplastic disease, unspecified tibia and fibula, sequela
M84.571A Pathological fracture in neoplastic disease, right ankle, initial encounter for fracture
M84.571D Pathological fracture in neoplastic disease, right ankle, subsequent encounter for fracture with routine healing
M84.571G Pathological fracture in neoplastic disease, right ankle, subsequent encounter for fracture with delayed healing
M84.571K Pathological fracture in neoplastic disease, right ankle, subsequent encounter for fracture with nonunion
M84.571P Pathological fracture in neoplastic disease, right ankle, subsequent encounter for fracture with malunion
M84.571S Pathological fracture in neoplastic disease, right ankle, sequela
M84.572A Pathological fracture in neoplastic disease, left ankle, initial encounter for fracture
M84.572D Pathological fracture in neoplastic disease, left ankle, subsequent encounter for fracture with routine healing
M84.572G Pathological fracture in neoplastic disease, left ankle, subsequent encounter for fracture with delayed healing
M84.572K Pathological fracture in neoplastic disease, left ankle, subsequent encounter for fracture with nonunion
M84.572P Pathological fracture in neoplastic disease, left ankle, subsequent encounter for fracture with malunion
M84.572S Pathological fracture in neoplastic disease, left ankle, sequela
M84.573A Pathological fracture in neoplastic disease, unspecified ankle, initial encounter for fracture
M84.573D Pathological fracture in neoplastic disease, unspecified ankle, subsequent encounter for fracture with routine healing
M84.573G Pathological fracture in neoplastic disease, unspecified ankle, subsequent encounter for fracture with delayed healing
M84.573K Pathological fracture in neoplastic disease, unspecified ankle, subsequent encounter for fracture with nonunion
M84.573P Pathological fracture in neoplastic disease, unspecified ankle, subsequent encounter for fracture with malunion
M84.573S Pathological fracture in neoplastic disease, unspecified ankle, sequela
M84.574A Pathological fracture in neoplastic disease, right foot, initial encounter for fracture
M84.574D Pathological fracture in neoplastic disease, right foot, subsequent encounter for fracture with routine healing
M84.574G Pathological fracture in neoplastic disease, right foot, subsequent encounter for fracture with delayed healing
M84.574K Pathological fracture in neoplastic disease, right foot, subsequent encounter for fracture with nonunion
M84.574P Pathological fracture in neoplastic disease, right foot, subsequent encounter for fracture with malunion
M84.574S Pathological fracture in neoplastic disease, right foot, sequela
M84.575A Pathological fracture in neoplastic disease, left foot, initial encounter for fracture
M84.575D Pathological fracture in neoplastic disease, left foot, subsequent encounter for fracture with routine healing
M84.575G Pathological fracture in neoplastic disease, left foot, subsequent encounter for fracture with delayed healing
M84.575K Pathological fracture in neoplastic disease, left foot, subsequent encounter for fracture with nonunion
M84.575P Pathological fracture in neoplastic disease, left foot, subsequent encounter for fracture with malunion
M84.575S Pathological fracture in neoplastic disease, left foot, sequela
M84.576A Pathological fracture in neoplastic disease, unspecified foot, initial encounter for fracture
M84.576D Pathological fracture in neoplastic disease, unspecified foot, subsequent encounter for fracture with routine healing
M84.576G Pathological fracture in neoplastic disease, unspecified foot, subsequent encounter for fracture with delayed healing
M84.576K Pathological fracture in neoplastic disease, unspecified foot, subsequent encounter for fracture with nonunion
M84.576P Pathological fracture in neoplastic disease, unspecified foot, subsequent encounter for fracture with malunion
M84.576S Pathological fracture in neoplastic disease, unspecified foot, sequela
M84.58XA Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture
M84.58XD Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with routine healing
M84.58XG Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with delayed healing
M84.58XK Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with nonunion
M84.58XP Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with malunion
M84.58XS Pathological fracture in neoplastic disease, other specified site, sequela

Group 3

(349 Codes)
Group 3 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for HCPCS code: J1740 (Boniva®). 

Group 3 Codes
Code Description
C79.51 Secondary malignant neoplasm of bone
C79.52 Secondary malignant neoplasm of bone marrow
M80.00XA Age-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
M80.00XD Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with routine healing
M80.00XG Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with delayed healing
M80.00XK Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with nonunion
M80.00XP Age-related osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with malunion
M80.00XS Age-related osteoporosis with current pathological fracture, unspecified site, sequela
M80.011A Age-related osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
M80.011D Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing
M80.011G Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing
M80.011K Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion
M80.011P Age-related osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion
M80.011S Age-related osteoporosis with current pathological fracture, right shoulder, sequela
M80.012A Age-related osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture
M80.012D Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing
M80.012G Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing
M80.012K Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion
M80.012P Age-related osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion
M80.012S Age-related osteoporosis with current pathological fracture, left shoulder, sequela
M80.019A Age-related osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture
M80.019D Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with routine healing
M80.019G Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing
M80.019K Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with nonunion
M80.019P Age-related osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with malunion
M80.019S Age-related osteoporosis with current pathological fracture, unspecified shoulder, sequela
M80.021A Age-related osteoporosis with current pathological fracture, right humerus, initial encounter for fracture
M80.021D Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing
M80.021G Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with delayed healing
M80.021K Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with nonunion
M80.021P Age-related osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with malunion
M80.021S Age-related osteoporosis with current pathological fracture, right humerus, sequela
M80.022A Age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture
M80.022D Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with routine healing
M80.022G Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with delayed healing
M80.022K Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with nonunion
M80.022P Age-related osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with malunion
M80.022S Age-related osteoporosis with current pathological fracture, left humerus, sequela
M80.029A Age-related osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture
M80.029D Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with routine healing
M80.029G Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with delayed healing
M80.029K Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with nonunion
M80.029P Age-related osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with malunion
M80.029S Age-related osteoporosis with current pathological fracture, unspecified humerus, sequela
M80.031A Age-related osteoporosis with current pathological fracture, right forearm, initial encounter for fracture
M80.031D Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with routine healing
M80.031G Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with delayed healing
M80.031K Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with nonunion
M80.031P Age-related osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with malunion
M80.031S Age-related osteoporosis with current pathological fracture, right forearm, sequela
M80.032A Age-related osteoporosis with current pathological fracture, left forearm, initial encounter for fracture
M80.032D Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing
M80.032G Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with delayed healing
M80.032K Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with nonunion
M80.032P Age-related osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with malunion
M80.032S Age-related osteoporosis with current pathological fracture, left forearm, sequela
M80.039A Age-related osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture
M80.039D Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with routine healing
M80.039G Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with delayed healing
M80.039K Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with nonunion
M80.039P Age-related osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with malunion
M80.039S Age-related osteoporosis with current pathological fracture, unspecified forearm, sequela
M80.041A Age-related osteoporosis with current pathological fracture, right hand, initial encounter for fracture
M80.041D Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing
M80.041G Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with delayed healing
M80.041K Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with nonunion
M80.041P Age-related osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with malunion
M80.041S Age-related osteoporosis with current pathological fracture, right hand, sequela
M80.042A Age-related osteoporosis with current pathological fracture, left hand, initial encounter for fracture
M80.042D Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with routine healing
M80.042G Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with delayed healing
M80.042K Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with nonunion
M80.042P Age-related osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with malunion
M80.042S Age-related osteoporosis with current pathological fracture, left hand, sequela
M80.049A Age-related osteoporosis with current pathological fracture, unspecified hand, initial encounter for fracture
M80.049D Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with routine healing
M80.049G Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with delayed healing
M80.049K Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with nonunion
M80.049P Age-related osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with malunion
M80.049S Age-related osteoporosis with current pathological fracture, unspecified hand, sequela
M80.051A Age-related osteoporosis with current pathological fracture, right femur, initial encounter for fracture
M80.051D Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing
M80.051G Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing
M80.051K Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion
M80.051P Age-related osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion
M80.051S Age-related osteoporosis with current pathological fracture, right femur, sequela
M80.052A Age-related osteoporosis with current pathological fracture, left femur, initial encounter for fracture
M80.052D Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing
M80.052G Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing
M80.052K Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion
M80.052P Age-related osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion
M80.052S Age-related osteoporosis with current pathological fracture, left femur, sequela
M80.059A Age-related osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture
M80.059D Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with routine healing
M80.059G Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with delayed healing
M80.059K Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with nonunion
M80.059P Age-related osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with malunion
M80.059S Age-related osteoporosis with current pathological fracture, unspecified femur, sequela
M80.061A Age-related osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture
M80.061D Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing
M80.061G Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with delayed healing
M80.061K Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion
M80.061P Age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with malunion
M80.061S Age-related osteoporosis with current pathological fracture, right lower leg, sequela
M80.062A Age-related osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture
M80.062D Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with routine healing
M80.062G Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with delayed healing
M80.062K Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with nonunion
M80.062P Age-related osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with malunion
M80.062S Age-related osteoporosis with current pathological fracture, left lower leg, sequela
M80.069A Age-related osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture
M80.069D Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with routine healing
M80.069G Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with delayed healing
M80.069K Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with nonunion
M80.069P Age-related osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with malunion
M80.069S Age-related osteoporosis with current pathological fracture, unspecified lower leg, sequela
M80.071A Age-related osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture
M80.071D Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with routine healing
M80.071G Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with delayed healing
M80.071K Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with nonunion
M80.071P Age-related osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with malunion
M80.071S Age-related osteoporosis with current pathological fracture, right ankle and foot, sequela
M80.072A Age-related osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture
M80.072D Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with routine healing
M80.072G Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing
M80.072K Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with nonunion
M80.072P Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with malunion
M80.072S Age-related osteoporosis with current pathological fracture, left ankle and foot, sequela
M80.079A Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture
M80.079D Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with routine healing
M80.079G Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with delayed healing
M80.079K Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with nonunion
M80.079P Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with malunion
M80.079S Age-related osteoporosis with current pathological fracture, unspecified ankle and foot, sequela
M80.08XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.08XD Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing
M80.08XG Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing
M80.08XK Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion
M80.08XP Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion
M80.08XS Age-related osteoporosis with current pathological fracture, vertebra(e), sequela
M80.0AXA Age-related osteoporosis with current pathological fracture, other site, initial encounter for fracture
M80.0AXD Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing
M80.0AXG Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing
M80.0AXK Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion
M80.0AXP Age-related osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion
M80.0AXS Age-related osteoporosis with current pathological fracture, other site, sequela
M80.0B1A Age-related osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
M80.0B1D Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing
M80.0B1G Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing
M80.0B1K Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion
M80.0B1P Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion
M80.0B1S Age-related osteoporosis with current pathological fracture, right pelvis, sequela
M80.0B2A Age-related osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture
M80.0B2D Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing
M80.0B2G Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing
M80.0B2K Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion
M80.0B2P Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion
M80.0B2S Age-related osteoporosis with current pathological fracture, left pelvis, sequela
M80.80XA Other osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
M80.80XD Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with routine healing
M80.80XG Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with delayed healing
M80.80XK Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with nonunion
M80.80XP Other osteoporosis with current pathological fracture, unspecified site, subsequent encounter for fracture with malunion
M80.80XS Other osteoporosis with current pathological fracture, unspecified site, sequela
M80.811A Other osteoporosis with current pathological fracture, right shoulder, initial encounter for fracture
M80.811D Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with routine healing
M80.811G Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with delayed healing
M80.811K Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with nonunion
M80.811P Other osteoporosis with current pathological fracture, right shoulder, subsequent encounter for fracture with malunion
M80.811S Other osteoporosis with current pathological fracture, right shoulder, sequela
M80.812A Other osteoporosis with current pathological fracture, left shoulder, initial encounter for fracture
M80.812D Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with routine healing
M80.812G Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with delayed healing
M80.812K Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with nonunion
M80.812P Other osteoporosis with current pathological fracture, left shoulder, subsequent encounter for fracture with malunion
M80.812S Other osteoporosis with current pathological fracture, left shoulder, sequela
M80.819A Other osteoporosis with current pathological fracture, unspecified shoulder, initial encounter for fracture
M80.819D Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with routine healing
M80.819G Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing
M80.819K Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with nonunion
M80.819P Other osteoporosis with current pathological fracture, unspecified shoulder, subsequent encounter for fracture with malunion
M80.819S Other osteoporosis with current pathological fracture, unspecified shoulder, sequela
M80.821A Other osteoporosis with current pathological fracture, right humerus, initial encounter for fracture
M80.821D Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with routine healing
M80.821G Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with delayed healing
M80.821K Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with nonunion
M80.821P Other osteoporosis with current pathological fracture, right humerus, subsequent encounter for fracture with malunion
M80.821S Other osteoporosis with current pathological fracture, right humerus, sequela
M80.822A Other osteoporosis with current pathological fracture, left humerus, initial encounter for fracture
M80.822D Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with routine healing
M80.822G Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with delayed healing
M80.822K Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with nonunion
M80.822P Other osteoporosis with current pathological fracture, left humerus, subsequent encounter for fracture with malunion
M80.822S Other osteoporosis with current pathological fracture, left humerus, sequela
M80.829A Other osteoporosis with current pathological fracture, unspecified humerus, initial encounter for fracture
M80.829D Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with routine healing
M80.829G Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with delayed healing
M80.829K Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with nonunion
M80.829P Other osteoporosis with current pathological fracture, unspecified humerus, subsequent encounter for fracture with malunion
M80.829S Other osteoporosis with current pathological fracture, unspecified humerus, sequela
M80.831A Other osteoporosis with current pathological fracture, right forearm, initial encounter for fracture
M80.831D Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with routine healing
M80.831G Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with delayed healing
M80.831K Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with nonunion
M80.831P Other osteoporosis with current pathological fracture, right forearm, subsequent encounter for fracture with malunion
M80.831S Other osteoporosis with current pathological fracture, right forearm, sequela
M80.832A Other osteoporosis with current pathological fracture, left forearm, initial encounter for fracture
M80.832D Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with routine healing
M80.832G Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with delayed healing
M80.832K Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with nonunion
M80.832P Other osteoporosis with current pathological fracture, left forearm, subsequent encounter for fracture with malunion
M80.832S Other osteoporosis with current pathological fracture, left forearm, sequela
M80.839A Other osteoporosis with current pathological fracture, unspecified forearm, initial encounter for fracture
M80.839D Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with routine healing
M80.839G Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with delayed healing
M80.839K Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with nonunion
M80.839P Other osteoporosis with current pathological fracture, unspecified forearm, subsequent encounter for fracture with malunion
M80.839S Other osteoporosis with current pathological fracture, unspecified forearm, sequela
M80.841A Other osteoporosis with current pathological fracture, right hand, initial encounter for fracture
M80.841D Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with routine healing
M80.841G Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with delayed healing
M80.841K Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with nonunion
M80.841P Other osteoporosis with current pathological fracture, right hand, subsequent encounter for fracture with malunion
M80.841S Other osteoporosis with current pathological fracture, right hand, sequela
M80.842A Other osteoporosis with current pathological fracture, left hand, initial encounter for fracture
M80.842D Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with routine healing
M80.842G Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with delayed healing
M80.842K Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with nonunion
M80.842P Other osteoporosis with current pathological fracture, left hand, subsequent encounter for fracture with malunion
M80.842S Other osteoporosis with current pathological fracture, left hand, sequela
M80.849A Other osteoporosis with current pathological fracture, unspecified hand, initial encounter for fracture
M80.849D Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with routine healing
M80.849G Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with delayed healing
M80.849K Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with nonunion
M80.849P Other osteoporosis with current pathological fracture, unspecified hand, subsequent encounter for fracture with malunion
M80.849S Other osteoporosis with current pathological fracture, unspecified hand, sequela
M80.851A Other osteoporosis with current pathological fracture, right femur, initial encounter for fracture
M80.851D Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with routine healing
M80.851G Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with delayed healing
M80.851K Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with nonunion
M80.851P Other osteoporosis with current pathological fracture, right femur, subsequent encounter for fracture with malunion
M80.851S Other osteoporosis with current pathological fracture, right femur, sequela
M80.852A Other osteoporosis with current pathological fracture, left femur, initial encounter for fracture
M80.852D Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with routine healing
M80.852G Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with delayed healing
M80.852K Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with nonunion
M80.852P Other osteoporosis with current pathological fracture, left femur, subsequent encounter for fracture with malunion
M80.852S Other osteoporosis with current pathological fracture, left femur, sequela
M80.859A Other osteoporosis with current pathological fracture, unspecified femur, initial encounter for fracture
M80.859D Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with routine healing
M80.859G Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with delayed healing
M80.859K Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with nonunion
M80.859P Other osteoporosis with current pathological fracture, unspecified femur, subsequent encounter for fracture with malunion
M80.859S Other osteoporosis with current pathological fracture, unspecified femur, sequela
M80.861A Other osteoporosis with current pathological fracture, right lower leg, initial encounter for fracture
M80.861D Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing
M80.861G Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with delayed healing
M80.861K Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with nonunion
M80.861P Other osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with malunion
M80.861S Other osteoporosis with current pathological fracture, right lower leg, sequela
M80.862A Other osteoporosis with current pathological fracture, left lower leg, initial encounter for fracture
M80.862D Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with routine healing
M80.862G Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with delayed healing
M80.862K Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with nonunion
M80.862P Other osteoporosis with current pathological fracture, left lower leg, subsequent encounter for fracture with malunion
M80.862S Other osteoporosis with current pathological fracture, left lower leg, sequela
M80.869A Other osteoporosis with current pathological fracture, unspecified lower leg, initial encounter for fracture
M80.869D Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with routine healing
M80.869G Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with delayed healing
M80.869K Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with nonunion
M80.869P Other osteoporosis with current pathological fracture, unspecified lower leg, subsequent encounter for fracture with malunion
M80.869S Other osteoporosis with current pathological fracture, unspecified lower leg, sequela
M80.871A Other osteoporosis with current pathological fracture, right ankle and foot, initial encounter for fracture
M80.871D Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with routine healing
M80.871G Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with delayed healing
M80.871K Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with nonunion
M80.871P Other osteoporosis with current pathological fracture, right ankle and foot, subsequent encounter for fracture with malunion
M80.871S Other osteoporosis with current pathological fracture, right ankle and foot, sequela
M80.872A Other osteoporosis with current pathological fracture, left ankle and foot, initial encounter for fracture
M80.872D Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with routine healing
M80.872G Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing
M80.872K Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with nonunion
M80.872P Other osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with malunion
M80.872S Other osteoporosis with current pathological fracture, left ankle and foot, sequela
M80.879A Other osteoporosis with current pathological fracture, unspecified ankle and foot, initial encounter for fracture
M80.879D Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with routine healing
M80.879G Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with delayed healing
M80.879K Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with nonunion
M80.879P Other osteoporosis with current pathological fracture, unspecified ankle and foot, subsequent encounter for fracture with malunion
M80.879S Other osteoporosis with current pathological fracture, unspecified ankle and foot, sequela
M80.88XA Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.88XD Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing
M80.88XG Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with delayed healing
M80.88XK Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with nonunion
M80.88XP Other osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with malunion
M80.88XS Other osteoporosis with current pathological fracture, vertebra(e), sequela
M80.8AXA Other osteoporosis with current pathological fracture, other site, initial encounter for fracture
M80.8AXD Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with routine healing
M80.8AXG Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with delayed healing
M80.8AXK Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with nonunion
M80.8AXP Other osteoporosis with current pathological fracture, other site, subsequent encounter for fracture with malunion
M80.8AXS Other osteoporosis with current pathological fracture, other site, sequela
M80.8B1A Other osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture
M80.8B1D Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing
M80.8B1G Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing
M80.8B1K Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion
M80.8B1P Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion
M80.8B1S Other osteoporosis with current pathological fracture, right pelvis, sequela
M80.8B2A Other osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture
M80.8B2D Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing
M80.8B2G Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing
M80.8B2K Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion
M80.8B2P Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion
M80.8B2S Other osteoporosis with current pathological fracture, left pelvis, sequela
M81.0 Age-related osteoporosis without current pathological fracture
M81.6 Localized osteoporosis [Lequesne]
M81.8 Other osteoporosis without current pathological fracture
M88.0 Osteitis deformans of skull
M88.1 Osteitis deformans of vertebrae
M88.811 Osteitis deformans of right shoulder
M88.812 Osteitis deformans of left shoulder
M88.819 Osteitis deformans of unspecified shoulder
M88.821 Osteitis deformans of right upper arm
M88.822 Osteitis deformans of left upper arm
M88.829 Osteitis deformans of unspecified upper arm
M88.831 Osteitis deformans of right forearm
M88.832 Osteitis deformans of left forearm
M88.839 Osteitis deformans of unspecified forearm
M88.841 Osteitis deformans of right hand
M88.842 Osteitis deformans of left hand
M88.849 Osteitis deformans of unspecified hand
M88.851 Osteitis deformans of right thigh
M88.852 Osteitis deformans of left thigh
M88.859 Osteitis deformans of unspecified thigh
M88.861 Osteitis deformans of right lower leg
M88.862 Osteitis deformans of left lower leg
M88.869 Osteitis deformans of unspecified lower leg
M88.871 Osteitis deformans of right ankle and foot
M88.872 Osteitis deformans of left ankle and foot
M88.879 Osteitis deformans of unspecified ankle and foot
M88.88 Osteitis deformans of other bones
M88.89 Osteitis deformans of multiple sites
M88.9 Osteitis deformans of unspecified bone
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.0X5D Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter
T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, sequela
T50.0X5A Adverse effect of mineralocorticoids and their antagonists, initial encounter
T50.0X5D Adverse effect of mineralocorticoids and their antagonists, subsequent encounter
T50.0X5S Adverse effect of mineralocorticoids and their antagonists, sequela

Group 4

(90 Codes)
Group 4 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for HCPCS code: J2430 (Aredia®).

Additional information beyond ICD-10-CM description: E83.52 Hypercalcemia (associated with malignancy)

Group 4 Codes
Code Description
C50.011* Malignant neoplasm of nipple and areola, right female breast
C50.012* Malignant neoplasm of nipple and areola, left female breast
C50.019* Malignant neoplasm of nipple and areola, unspecified female breast
C50.021* Malignant neoplasm of nipple and areola, right male breast
C50.022* Malignant neoplasm of nipple and areola, left male breast
C50.029* Malignant neoplasm of nipple and areola, unspecified male breast
C50.111* Malignant neoplasm of central portion of right female breast
C50.112* Malignant neoplasm of central portion of left female breast
C50.119* Malignant neoplasm of central portion of unspecified female breast
C50.121* Malignant neoplasm of central portion of right male breast
C50.122* Malignant neoplasm of central portion of left male breast
C50.129* Malignant neoplasm of central portion of unspecified male breast
C50.211* Malignant neoplasm of upper-inner quadrant of right female breast
C50.212* Malignant neoplasm of upper-inner quadrant of left female breast
C50.219* Malignant neoplasm of upper-inner quadrant of unspecified female breast
C50.221* Malignant neoplasm of upper-inner quadrant of right male breast
C50.222* Malignant neoplasm of upper-inner quadrant of left male breast
C50.229* Malignant neoplasm of upper-inner quadrant of unspecified male breast
C50.311* Malignant neoplasm of lower-inner quadrant of right female breast
C50.312* Malignant neoplasm of lower-inner quadrant of left female breast
C50.319* Malignant neoplasm of lower-inner quadrant of unspecified female breast
C50.321* Malignant neoplasm of lower-inner quadrant of right male breast
C50.322* Malignant neoplasm of lower-inner quadrant of left male breast
C50.329* Malignant neoplasm of lower-inner quadrant of unspecified male breast
C50.411* Malignant neoplasm of upper-outer quadrant of right female breast
C50.412* Malignant neoplasm of upper-outer quadrant of left female breast
C50.419* Malignant neoplasm of upper-outer quadrant of unspecified female breast
C50.421* Malignant neoplasm of upper-outer quadrant of right male breast
C50.422* Malignant neoplasm of upper-outer quadrant of left male breast
C50.429* Malignant neoplasm of upper-outer quadrant of unspecified male breast
C50.511* Malignant neoplasm of lower-outer quadrant of right female breast
C50.512* Malignant neoplasm of lower-outer quadrant of left female breast
C50.519* Malignant neoplasm of lower-outer quadrant of unspecified female breast
C50.521* Malignant neoplasm of lower-outer quadrant of right male breast
C50.522* Malignant neoplasm of lower-outer quadrant of left male breast
C50.529* Malignant neoplasm of lower-outer quadrant of unspecified male breast
C50.611* Malignant neoplasm of axillary tail of right female breast
C50.612* Malignant neoplasm of axillary tail of left female breast
C50.619* Malignant neoplasm of axillary tail of unspecified female breast
C50.621* Malignant neoplasm of axillary tail of right male breast
C50.622* Malignant neoplasm of axillary tail of left male breast
C50.629* Malignant neoplasm of axillary tail of unspecified male breast
C50.811* Malignant neoplasm of overlapping sites of right female breast
C50.812* Malignant neoplasm of overlapping sites of left female breast
C50.819* Malignant neoplasm of overlapping sites of unspecified female breast
C50.821* Malignant neoplasm of overlapping sites of right male breast
C50.822* Malignant neoplasm of overlapping sites of left male breast
C50.829* Malignant neoplasm of overlapping sites of unspecified male breast
C50.911* Malignant neoplasm of unspecified site of right female breast
C50.912* Malignant neoplasm of unspecified site of left female breast
C50.919* Malignant neoplasm of unspecified site of unspecified female breast
C50.921* Malignant neoplasm of unspecified site of right male breast
C50.922* Malignant neoplasm of unspecified site of left male breast
C50.929* Malignant neoplasm of unspecified site of unspecified male breast
C79.51* Secondary malignant neoplasm of bone
C79.52* Secondary malignant neoplasm of bone marrow
C90.00 Multiple myeloma not having achieved remission
C90.01 Multiple myeloma in remission
C90.02 Multiple myeloma in relapse
E83.52 Hypercalcemia
M81.0 Age-related osteoporosis without current pathological fracture
M81.6 Localized osteoporosis [Lequesne]
M81.8 Other osteoporosis without current pathological fracture
M88.0 Osteitis deformans of skull
M88.1 Osteitis deformans of vertebrae
M88.811 Osteitis deformans of right shoulder
M88.812 Osteitis deformans of left shoulder
M88.819 Osteitis deformans of unspecified shoulder
M88.821 Osteitis deformans of right upper arm
M88.822 Osteitis deformans of left upper arm
M88.829 Osteitis deformans of unspecified upper arm
M88.831 Osteitis deformans of right forearm
M88.832 Osteitis deformans of left forearm
M88.839 Osteitis deformans of unspecified forearm
M88.841 Osteitis deformans of right hand
M88.842 Osteitis deformans of left hand
M88.849 Osteitis deformans of unspecified hand
M88.851 Osteitis deformans of right thigh
M88.852 Osteitis deformans of left thigh
M88.859 Osteitis deformans of unspecified thigh
M88.861 Osteitis deformans of right lower leg
M88.862 Osteitis deformans of left lower leg
M88.869 Osteitis deformans of unspecified lower leg
M88.871 Osteitis deformans of right ankle and foot
M88.872 Osteitis deformans of left ankle and foot
M88.879 Osteitis deformans of unspecified ankle and foot
M88.88 Osteitis deformans of other bones
M88.89 Osteitis deformans of multiple sites
M88.9 Osteitis deformans of unspecified bone
Z85.3* Personal history of malignant neoplasm of breast
Group 4 Medical Necessity ICD-10-CM Codes Asterisk Explanation

Dual Diagnosis Requirement - The billing of Pamidronate for osteolytic bone metastases of breast cancer requires a dual diagnosis. ICD-10-CM code C79.51 or C79.52 must be billed with the related neoplasm codes marked with an asterisk. The ICD-10-CM codes marked with an asterisk may NOT be billed alone.

Group 5

(8 Codes)
Group 5 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for HCPCS code: J3489 (Zometa®).

Additional information beyond ICD-10-CM description: E83.52 Hypercalcemia (associated with malignancy)

Group 5 Codes
Code Description
C79.51 Secondary malignant neoplasm of bone
C79.52 Secondary malignant neoplasm of bone marrow
C90.00 Multiple myeloma not having achieved remission
C90.01 Multiple myeloma in remission
C90.02 Multiple myeloma in relapse
E83.52 Hypercalcemia
M89.9 Disorder of bone, unspecified
M94.9 Disorder of cartilage, unspecified

Group 6

(35 Codes)
Group 6 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for HCPCS code: J3489 (Reclast®).

Group 6 Codes
Code Description
M81.0 Age-related osteoporosis without current pathological fracture
M81.6 Localized osteoporosis [Lequesne]
M81.8 Other osteoporosis without current pathological fracture
M88.0 Osteitis deformans of skull
M88.1 Osteitis deformans of vertebrae
M88.811 Osteitis deformans of right shoulder
M88.812 Osteitis deformans of left shoulder
M88.819 Osteitis deformans of unspecified shoulder
M88.821 Osteitis deformans of right upper arm
M88.822 Osteitis deformans of left upper arm
M88.829 Osteitis deformans of unspecified upper arm
M88.831 Osteitis deformans of right forearm
M88.832 Osteitis deformans of left forearm
M88.839 Osteitis deformans of unspecified forearm
M88.841 Osteitis deformans of right hand
M88.842 Osteitis deformans of left hand
M88.849 Osteitis deformans of unspecified hand
M88.851 Osteitis deformans of right thigh
M88.852 Osteitis deformans of left thigh
M88.859 Osteitis deformans of unspecified thigh
M88.861 Osteitis deformans of right lower leg
M88.862 Osteitis deformans of left lower leg
M88.869 Osteitis deformans of unspecified lower leg
M88.871 Osteitis deformans of right ankle and foot
M88.872 Osteitis deformans of left ankle and foot
M88.879 Osteitis deformans of unspecified ankle and foot
M88.88 Osteitis deformans of other bones
M88.89 Osteitis deformans of multiple sites
M88.9 Osteitis deformans of unspecified bone
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.0X5D Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter
T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, sequela
T50.0X5A Adverse effect of mineralocorticoids and their antagonists, initial encounter
T50.0X5D Adverse effect of mineralocorticoids and their antagonists, subsequent encounter
T50.0X5S Adverse effect of mineralocorticoids and their antagonists, sequela
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
12/14/2023 R4

This article is being retired effective for dates on service on and after 12/14/2023 in response to the related LCD being retired.

10/01/2023 R3

Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following codes have been added and the article revised to reflect the changes: Group 1: M80.0B1A, M80.0B1D, M80.0B1G, M80.0B1K, M80.0B1P, M80.0B1S, M80.0B2A, M80.0B2D, M80.0B2G, M80.0B2K, M80.0B2P, M80.0B2S, M80.8B1A, M80.8B1D, M80.8B1G, M80.8B1K, M80.8B1P, M80.8B1S, M80.8B2A, M80.8B2D, M80.8B2G, M80.8B2K, M80.8B2P, and M80.8B2S. Added to Group 3: M80.0B1A, M80.0B1D, M80.0B1G, M80.0B1K, M80.0B1P, M80.0B1S, M80.0B2A, M80.0B2D, M80.0B2G, M80.0B2K, M80.0B2P, M80.0B2S, M80.8B1A, M80.8B1D, M80.8B1G, M80.8B1K, M80.8B1P, M80.8B1S, M80.8B2A, M80.8B2D, M80.8B2G, M80.8B2K, M80.8B2P, and M80.8B2S.

10/01/2020 R2

Revision Number: 2
Publication: September 2020 Connection
LCR A/B2020-065

Explanation of revision: Based on CR 11895 and CR 11845 (Annual 2021 ICD-10-CM Update), the “ICD-10 Codes that Support Medical Necessity/ Group 1 Codes: and Group 3 Codes:” sections of this billing and coding article was revised to add the following ICD-10-CM codes: M80.0AXA, M80.0AXD, M80.0AXG, M80.0AXK, M80.0AXP, M80.0AXS, M80.8AXA, M80.8AXD, M80.8AXG, M80.8AXK, M80.8AXP, M80.8AXS. In addition, formatting changes have been made throughout the article. The effective date of this revision is based on date of service.

10/15/2019 R1

Explanation of Revision: It was determined that during the process of moving the ICD-10-CM diagnosis codes to the billing and coding article and listing them individually, the following ICD-10-CM diagnosis codes were omitted in error.

  • ICD-10-CM diagnosis code M84.569D has been added to the “Group 2 Codes” section.
  • ICD-10-CM diagnosis code M88.839 has been added to the “Group 4 Codes” section.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
12/14/2023 10/01/2023 - 12/14/2023 Retired You are here
10/20/2023 10/01/2023 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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