What is the ICD-10 code for a patient with severe osteoporosis, as indicated by a bone density study showing a T-score of -4.55 in the spine and -2.63 in the femoral neck, with a history of rheumatoid arthritis, stage 3b chronic kidney disease (CKD), and history of falls, who is prescribed alendronate and potentially an anabolic agent?

From the Guidelines

The ICD-10 code for severe osteoporosis as described in this case would be M81.0 (Age-related osteoporosis without current pathological fracture). This code is appropriate based on the bone density study results showing T-scores of -4.55 in the spine and -2.63 in the femoral neck, which meet the criteria for osteoporosis (T-score of -2.5 or lower) 1. If there were evidence of a current pathological fracture, the code would be M80.0 instead. Given the patient's complex medical history including rheumatoid arthritis, chronic kidney disease, and history of falls, this primary diagnosis code should be used when documenting the osteoporosis treatment plan, including the prescribed alendronate therapy or when referring to the rheumatologist for consideration of anabolic agent therapy. Some key points to consider in this case include:

• The patient's severe osteoporosis diagnosis is based on the bone density study results, which show a T-score of -4.55 in the spine and -2.63 in the femoral neck 1.
• The American College of Physicians recommends pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women with known osteoporosis 1.
• The patient's complex medical history, including rheumatoid arthritis and chronic kidney disease, should be taken into account when developing the treatment plan.
• Secondary codes for the patient's comorbidities (rheumatoid arthritis, CKD) would also be appropriate to include in the full documentation. The ICD-10 code M81.0 is the most appropriate code for this patient's severe osteoporosis diagnosis, and it should be used in conjunction with other relevant codes to ensure accurate documentation and billing.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

ICD-10 Code for Osteoporosis

• The ICD-10 code for osteoporosis is M80-M85, with M80 specifically referring to osteoporosis with fracture, and M81 referring to osteoporosis without fracture 2.
• In this case, the patient has a T-score of -4.55 in the spine and -2.63 in the femoral neck, indicating severe osteoporosis, and has a history of falls, which puts them at a higher risk for fractures.
• The ICD-10 code for this patient would be M81.0, which refers to osteoporosis without fracture, as there is no mention of a current fracture.

Alendronate Treatment

• Alendronate is a bisphosphonate that is commonly used to treat osteoporosis, and has been shown to increase bone mineral density and reduce the risk of fractures 3, 4.
• The patient's rheumatologist may consider adding an anabolic agent to their treatment regimen to continue managing their osteoporosis, as alendronate is an antiresorptive agent that only slows down bone loss.
• It is also important to monitor the patient's renal function closely while they are on alendronate, as they have stage 3b CKD, and alendronate may not be recommended for patients with severe renal impairment 5.

Rheumatoid Arthritis and Osteoporosis

• The patient has rheumatoid arthritis, which increases their risk for osteoporosis, and they are currently being treated with Rinvoq, a medication that can also increase the risk of osteoporosis.
• Studies have shown that alendronate can be effective in treating osteoporosis in patients with rheumatoid arthritis, and that combined therapy with alendronate and menatetrenone (VitK2) may be beneficial for postmenopausal RA patients with osteoporosis or osteopenia 6.