What is the ICD-10 (International Classification of Diseases, 10th Revision) code for bone density?

ICD-10 Coding for Bone Density Testing and Conditions

The specific ICD-10 code depends on what you're documenting: for ordering bone density screening, use Z13.820 (encounter for screening for osteoporosis); for abnormal findings, use Z78.0 (asymptomatic menopausal state) or M85.8 (other specified disorders of bone density and structure); for diagnosed osteoporosis, use M81.0 (age-related osteoporosis without current pathological fracture) or M80.0 (osteoporosis with current pathological fracture).

Common ICD-10 Codes for Bone Density Scenarios

Screening and Surveillance Codes

• Z13.820 - Encounter for screening for osteoporosis is the primary code when ordering DXA bone mineral density testing for screening purposes in at-risk populations 1
• This code applies to women ≥65 years, men ≥70 years, or younger individuals with risk factors including estrogen deficiency, low body mass (<127 lb), maternal hip fracture history, or current smoking 1

Abnormal Bone Density Findings

• M85.80 - Other specified disorders of bone density and structure, unspecified site is used when documenting low bone mass or osteopenia (T-score between -1.0 and -2.5) 1
• M85.8 codes can be further specified by anatomic site (e.g., M85.85 for pelvic region, M85.88 for other sites) 1

Diagnosed Osteoporosis

• M81.0 - Age-related osteoporosis without current pathological fracture is used for T-score ≤ -2.5 without active fracture 1
• M80.0 series - Osteoporosis with current pathological fracture requires site-specific coding (e.g., M80.08 for vertebral fracture, M80.05 for femur) 1
• These codes require 7th character extensions: A (initial encounter), D (subsequent encounter), or S (sequela) 1

Age and Gender-Specific Considerations

Premenopausal Women and Men <50 Years

• Use Z-score documentation rather than T-score classification, as WHO criteria don't apply to this population 1
• M85.8 codes are appropriate when Z-score ≤ -2.0 indicates bone density "below expected range for age" 1
• Consider secondary causes requiring additional codes for underlying conditions (e.g., E28.3 for premature ovarian failure, M05.9 for rheumatoid arthritis) 1

Postmenopausal Women and Men ≥50 Years

• Use T-score classification with WHO criteria: normal (>-1.0), osteopenia (-1.0 to -2.4), osteoporosis (≤-2.5) 1
• Z78.0 - Asymptomatic menopausal state can be used as secondary code for postmenopausal women undergoing screening 1

Special Population Codes

Cancer Survivors

• Z85 series - Personal history of malignant neoplasm should be included when coding for bone density surveillance in childhood, adolescent, and young adult cancer survivors 1
• Z92.25 - Personal history of immunosuppression therapy applies to those treated with corticosteroids 1
• Z92.3 - Personal history of irradiation is relevant for those who received cranial/spinal or total body irradiation 1

Monitoring and Follow-Up Codes

• Z09 - Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm is used for repeat DXA to assess therapy effectiveness 1
• Z79.83 - Long-term (current) use of bisphosphonates or other osteoporosis medications should be documented when monitoring treatment response 1

Common Pitfalls to Avoid

Coding Accuracy Issues

• Do not use screening codes (Z13.820) when documenting established osteoporosis or monitoring treatment - use the appropriate M80 or M81 codes instead 1
• Ensure fracture codes (M80 series) include the required 7th character for encounter type, as incomplete coding leads to claim denials 1
• Avoid using osteopenia codes (M85.8) interchangeably with osteoporosis codes (M81.0) - these represent distinct diagnostic categories with different treatment implications 1

Documentation Requirements

• Always document the specific T-score or Z-score value in the medical record, as the numeric value determines appropriate code selection 1
• Include anatomic site specificity when coding M80 or M85 series, as this affects reimbursement and clinical tracking 1
• Document risk factors separately using appropriate codes (e.g., F17.210 for nicotine dependence, Z87.310 for personal history of estrogen therapy) to support medical necessity 1

Clinical Context Considerations

• Recognize that ICD-10 coding reliability varies - studies show only moderate agreement (Kappa 0.42) for terminal codes even among specialists, so clear documentation is essential 2, 3
• For patients with fragility fractures, always code both the fracture (M80 series) and any underlying conditions that contributed to bone fragility 1
• When FRAX scores indicate treatment despite T-score >-2.5, document both the osteopenia code (M85.8) and relevant risk factors to justify pharmacologic intervention 1