WCHQ Ambulatory Measure Specification Screening For Osteoporosis Measurement Period 07/01/16-06/30/17 Submission Period: 09/05/17-10/20/17

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1 MEASURE DESCRIPTION The percentage of women age 65 through 85 who had a minimum of one bone densitometry test at age 60 or above or have a diagnosis of osteoporosis or osteopenia. Disclaimer: Measures reported by WCHQ healthcare organizations represent a specific aspect of care in relation to an evidence-based standard, but are not clinical guidelines and do not establish standards of care. All providers should have an individual care plan established with their patient. GENERAL INFORMATION/RATIONALE The USPSTF found good evidence that the risk for osteoporosis and fracture increases with age (and other factors). They also found that bone density measurements accurately predict the risk for fractures in the short-term and that treating asymptomatic women with osteoporosis reduces their risk for fracture. The benefits of screening and treatment are of at least moderate magnitude for women at increased risk by virtue of age or the presence of other risk factors. No recommendation has been made by the USPSTF for or against screening for osteoporosis in postmenopausal women younger than 60 or in women who are not at increased risk for an osteoporotic fracture 1. The National Osteoporosis Foundation recommends a bone density screening for all women at 65 years and older regardless of their risk factors 2. Reference 1. Screening for Osteoporosis. U.S. Preventive Services Task Force. September, NOF Guidelines. National Osteoporosis Foundation DEFINITIONS 12 Months: Measurement Period 24 Months: Measurement Period + Prior Year 36 Months: Measurement Period plus Prior Two Years Office Visit: Office visit in an outpatient, non-urgent care setting Encounter: Any type of visit to any type of service PCP: For WCHQ measure purposes, a primary care provider is defined as any General Practice, Internal Medicine, Family Medicine, Pediatrics provider with the following degree types (MD, DO, PA, and NP), and any other practitioners identified by the healthcare system as primary care practitioners. The rationale for the additional practitioner(s) must be documented and must be applied consistently across all preventive care and chronic care measures by the organization. Measure Specific Specialist: For this measure, visits to an OB-GYN qualify as office visits for the denominator population. Age Range 65-85: Patients born between 07/01/1931 and 07/01/1951. DENOMINATOR DESCRIPTION Women whose age at the beginning of the one year measurement period is at least 65 and whose age at the end of the one year measurement period is less than 86 and who are alive as of the last day of the Measurement Period. Expired patients for whom a specific date of expiration cannot be found are excluded from the denominator population. The rationale for the denominator population is built from the following criteria (See Figure O-1) [Question 1] Is this patient whose care is managed within the physician group? [Question 2] - Is this a patient currently managed in our system? [Question 3] Is this patient eligible for a bone densitometry test? 1

2 MINIMUM POPULATION SIZE Organization Level Reporting: For every WCHQ Ambulatory Measure, each organization must calculate the total denominator population for this measure, not a sample (see Encounter Data section). If the Denominator for any given measure is less than 50 patients, the organization does not have to report the Numerator for the measure to WCHQ. To allow for appropriate comparisons of performance across organizations, a minimum population of 50 patients ensures a maximum of a 2% incremental scale on proportional measures. Publication on the Website: If the Denominator is less than 50, only the Physician Group Name, Population Size (N), and the following statement will display on The patient population is too small (N<50) for purposes of reliably predicting Physician Group performance. Historical Trend for Low Population Sizes: The historical trend display of Physician Group performance will not include measurement periods with population sizes less than 50. For each measurement period with insufficient data, there will be no display for that period. Site Level Reporting: Denominator Minimum: For site level reporting there must be a minimum of 100 patients per clinic in the denominator for each measure. If the clinic denominator for any given measure is less than 100 patients the organization does not publicly report the results for the measure. The results will still be included in the organization level data. Provider Minimum per Clinic: For site level reporting there are two options as follows: o A minimum of 3 providers per clinic who have patients in the measure denominator. There could be a provider or providers in a given clinic who do not get counted because they have no patients in the measure denominator. o If an organization desires, they can report site level data for a clinic with fewer than 3 providers as long as the clinic meets the 100 patient threshold. If your organization is planning to report results publicly for clinics with less than 3 providers, all clinics that meet this criteria will need to be reported. Publication on the Website: Clinics who do not have enough providers or patients to be publicly reported for a given measure or measures will still display on the website by name but without results and with a caveat indicating that data was reported but did not meet the minimum provider or population size. Provider and /or Clinic Attrition Recommendation: 1. If a provider or clinic has left the organization prior to the end of the measurement period and if the organization can track the provider termination date, the provider will not be included in the site level reporting results. The provider or clinic is still included in the group level results. 2. If a clinic closes or is no longer affiliated with a health care system after the end of the measurement period and prior to next year s data being published a termination date and verbiage will be added next to that clinic s name on the website. This will require website updating throughout the year. 2

3 Assignment of Provider to Clinic: Organizations can use their current internal site level reporting methodology to assign a provider to a clinic. A provider must be assigned to a home clinic. Organizations who are not already doing internal site level reporting can work with WCHQ for assistance. Assignment of Patient to Provider: For purposes of WCHQ site level reporting a patient must be attributed to one provider. Organizations can use their own internal algorithm to assign a patient to a provider. Those who are not already doing this can work with WCHQ for assistance. ENCOUNTER DATA Patients eligible for inclusion in the denominator include (See Figure O-1): [Question 1] Is this a patient whose care is managed within the physician group? Women who had at least two Primary Care office visits (Table O -1), regardless of diagnosis code, on different dates of service, to a PCP and/or OB/GYN in the past 36 months (Measurement Period plus Prior Two Years). If OB/GYN is not considered a PCP, at least one of the two office visits must be to a PCP. [Question 2] Is this a patient currently managed in our system? Women who had at least one Primary Care office visit (Table O-1) regardless of diagnosis code, with a PCP and/or OB/GYN in the most recent 24 months (Measurement Period plus Prior Year). [Question 3] Is this a patient that is eligible for a bone densitometry test? No exclusions apply. NUMERATOR DESCRIPTION The number of eligible women in the denominator who have had a bone densitometry test performed at age 60 or above or who have a diagnosis of osteoporosis or osteopenia prior to the end of the Measurement Period. Administrative data which can include: o Table O-2 Codes to identify bone densitometry testing requiring date of service. o Documentation indicating bone densitometry testing was done requiring year or date range that test was performed. The date range must have occurred after the age of 60 and before the end of the measurement period. o Table O-3 Codes to identify osteoporosis or osteopenia requiring date of service with an unlimited look back. o An osteoporosis or osteopenia diagnosis from an ICD-9 or ICD-10 based problem list requiring date of documentation with an unlimited look back. NOTE: This data can include internal, external and/or patient reported data extracted electronically from an Electronic Medical Record (EMR). Medical Record Review (Refer to Medical Record Review for Numerator Inclusion/Denominator Exclusion section) 3

4 WCHQ Ambulatory Care Measures Denominator/Numerator WCHQ Preventive Care Measure Figure O-1 Question 3: Is this a Patient that is eligible for a bone densitometry test? KEY 12 Months = Measurement Period 24 Months = Measurement Period + Prior Year 36 Months = Measurement Period + Prior Two Years Office Visit = CPT/HCPCS Codes from Table O-1 Primary Care Office Visit = Office Visit in an Outpatient, Non-Urgent Care setting PCP = Any General Practice, Internal Medicine, Family Medicine, Pediatrics provider with the following degree types (MD, DO, PA, and NP), and any other practitioners identified by the healthcare system as primary care practitioners Measure-Specific Specialist = For this measure, visits to an OB-GYN qualify as office visits for the denominator population. Bone Densitometry Test = CPT, HCPCS, ICD-9-CM Code from Table O-2 or EMR Documentation Osteoporosis or Osteopenia = ICD-9-CM Code from Table O-3 or EMR Documentation Age Range Patients born between 07/01/1931 and 07/01/1951 Physician Group Administrative Billing Electronic Health Record Data Warehouse Question 1: Is this a Patient our Physician Group Manages? Question 2: Is this a Patient that is current in our System? Out No No Exclusions Apply Yes Patient has at least one Primary Care Office Visit w/pcp and/or OB-GYN in 24 Months (Any Dx) (Table O-1) No Screening for Osteoporosis Denominator (patients eligible for a bone densitometry test) BUILD NUMERATOR Patient has a minimum of one bone densitometry test at age 60 or above (Table O-2) or one diagnosis of Osteoporosis or Osteopenia within lifetime (Table O-3) All Office Visits in 36 Months Women whose age at the beginning of the one year measurement period is at least 65 and whose age at the end of the one year measurement period is less than 86 and who are alive as of the last day of the Measurement Period. Yes Patient has at least two Primary Care Office Visiits w/pcp and/or OB-GYN in 36 Months (Any Dx) (Table O-1) Yes Yes Screening for Osteoporosis Numerator April 2017 No Out If the OB-GYN is not considered a PCP, one of the two office visits must be to a PCP 4

5 SAMPLING METHODOLOGY Organizations unable to collect numerator data by electronic means can do so by using the following criteria for chart review; The Sample size for chart review is determined based in the following criteria: c = 95% Confidence Interval E = 5% Margin of Error N = Total number of patients in the denominator pool Use the Sample Size Generator at the Wisconsin Collaborative for Healthcare Quality website ( and enter values to generate the sample size appropriate for your organization A 10% over sample is recommended beyond the generated sample size. INTERNALLY DEVELOPED CODES DATA TRANSLATION/MAPPING REQUIREMENTS If a medical group utilizes internally generated codes to identify specific services or events required for a given WCHQ performance measure, the group may translate or map the information to the WCHQ performance measurement specifications. The medical group must assure that the internally generated code matches the clinical specificity of the standard (ICD-9 or 10, CPT) codes included in the WCHQ performance measurement specifications. In order to use internally developed codes for WCHQ performance measure reporting, the medical group needs to document the translation/mapping to the codes in the specifications. This documentation should include the internally generated code, a description of the internally developed code, any additional clinical information for the internally developed code, and the equivalent standard code with description from the WCHQ performance measurement specifications. Once the translation/ mapping documentation is established, the medical group s WCHQ performance measurement team must review the mapping on a yearly basis and document that internally developed codes have not changed and are being used in the manner described in the translation/ mapping document. The medical group must have documented processes in place for adding codes to the medical group s administrative data system and procedures to implement the internally developed codes. MEDICAL RECORD REVIEW FOR NUMERATOR INCLUSION/DENOMINATOR EXCLUSION If appropriate, and/or when necessary, every organization may complement their electronic capture of patient medical history with electronic or manual record review. The following criteria apply only to data captured/reviewed during medical record review. Numerator Inclusion For WCHQ Preventive Screening Measures, which can include, internal, external, and/or patient reported information, proof of numerator compliance requires one of the following: o Documentation indicating bone densitometry testing was done requiring year or date range that test was performed. The date range must have occurred after the age of 60 and before the end of the measurement period. o An osteoporosis or osteopenia diagnosis requiring date of documentation with an unlimited look back. The diagnosis must have occurred prior to the end of the measurement period. 5

6 Denominator Exclusion For all WCHQ Measures proof of Denominator exclusion requires: Existence of exclusion criteria: o NOTE: No exclusions apply to this measure These data may be retrieved, in whole or in part, from any of the following: Notation in Progress Note Notation in Medical History or Surgical History Flag/Field in Electronic Medical Record Documentation in patient chart REQUIRED DATA SUBMISSION FIELDS Fields required for data submission for this measure depend upon the methodology used. The fields are as follows: TOTAL POPULATION METHODOLOGY: Population Denominator (N) (Patients Eligible for a Bone Densitometry Test) Numerator (Patients who had a minimum of one Bone Densitometry Test or one diagnosis of Osteoporosis or Osteopenia) Upon entry of these numbers, the rate is automatically calculated RANDOM SAMPLE METHODOLOGY: Population Denominator (N) (Patients Eligible for a Bone Densitometry Test) Population Sample (n) (r) (Patients in Denominator Population whose records will be reviewed) o (n)=population Sample and (r)=patients Reviewed equal the same number o The Population Sample size must be determined using the WCHQ Sample Calculator Numerator (Patients who had a minimum of one Bone Densitometry Test or one diagnosis of Osteoporosis or Osteopenia from Population Sample) Upon entry of these numbers, the rate is automatically calculated HYBRID METHODOLOGY: Population Denominator (N) (Patients Eligible for a Bone Densitometry Test) Administrative Review Denominator (Patients in Total Denominator Population whose numerator information is obtained through administrative data) Administrative Review Denominator (Patients in Total Denominator Population whose numerator information is obtained through administrative data) Administrative Review Numerator (Patients who had a minimum of one Bone Densitometry Test or one diagnosis of Osteoporosis or Osteopenia found through administrative data) Manual Review Denominator (Patients in Total Denominator Population whose numerator information cannot be obtained through administrative data) Manual Review Sample Size (Patients in Manual Review Denominator Population whose records will be reviewed) o The Manual Review Sample size must be determined using the WCHQ Sample Calculator plus a 10% over sample Manual Review Numerator (Patients who had a minimum of one Bone Densitometry Test or one diagnosis of Osteoporosis or Osteopenia found through Manual Review Sampling) 6

7 Upon entry of these numbers, the Rates, Weight Factors and Total Reviewed are automatically calculated. Total Reviewed equals Administrative Review Denominator + Manual Review Sample Size. Site Level Reporting: Non-RBS Organizations: 1. Refer to the Non-RBS Site Level Reporting Upload Template.xls for specific instructions. RBS Organizations: 1. Refer to the RBS Site Level Reporting Upload Template.xls for specific instructions. PAYER STRATIFICATION: 1. Denominator data submission is requested by Payer Stratification for Medicare, Medicaid, Commercial and Uninsured. 2. Numerator data submission can be entered by primary payer category only for total population methodology Refer to Appendix A for definitions of the payer stratification categories. FIELDS REQUIRED FOR MEASURE VALIDATION Validation of this measure will require patient level data files for Administrative Data and/or for Manual Review. The following indicates fields needed for validation, which may be helpful to consider when querying the measure: Denominator Data File fields: 1. Patient Identifier (can be medical record number or other ID) 2. Office Visit Dates 3. Provider Specialty 4. Patient Date of Birth 5. Patient Gender Numerator Data File fields: 1. Patient Identifier (can be medical record number or other ID) 2. Bone Densitometry Code from Table O-2, or 3. Other Bone Densitometry Documentation, or 4. Osteoporosis or Osteopenia Code from Table O-3, or 5. Documentation of Osteoporosis or Osteopenia diagnosis 6. Date of Service of Bone Densitometry Test code, or 7. Year or Date Range of documented Bone Densitometry Test, or 8. Date of Service of Osteoporosis or Osteopenia code, or 9. Date of documentation of Osteoporosis or Osteopenia diagnosis Site Level Reporting fields: Clinic Name Period Metric ID Clinical Topic Measure 7

8 Clinic ID Clinic Name Metric Level (for A1C and LDL Testing and Control measures) Payer (optional) Numerator Denominator Percentage Provider Count Provider Minimum Count Flag Patient Minimum Count Flag Appendix A Primary Payer In keeping with the changing atmosphere of quality measurement and reporting, WCHQ would like for participating organizations to include the primary payer source with their data submissions for the ambulatory care measures. The primary payer source should be identified in the denominator upon answering the question, Is this patient current in our system? Once it has been determined that a patient is current because of a visit to their physician within the specified time period (12 months for chronic care measures and 24 months for preventive care measures), the payer should be pulled into the query. The primary payer should be the payer at the most recent office visit within the measurement period. There will be four categories of primary payer that will need to be submitted to WCHQ via the data submission tool: Medicare FFS, Medicaid (all types), Commercial (including Medicare HMO) and Uninsured/Self-Pay. The raw numbers for the denominator and numerator should be included for all three types of data submission, total population, hybrid, and sample. Rationale Opportunities exist for WCHQ to collect and report data on specific populations, like the Medicare population, through grant applications to begin to understand the disparities in quality of care. The purpose of this is to begin to understand the challenges of putting in additional data elements and complexities of data display for public reporting. At this time, the primary payer information will not be publicly reported. Definitions: Commercial: All plans not Medicaid or Medicare FFS (Includes VA, DoD, etc.) FFS Medicare: FFS plans, not Medicare HMO (Medicare Railroad is FFS Medicare) Medicaid: All Medicaid plans including those managed by commercial plans Uninsured: Self-pay individuals 8

9 APPENDIX B Code tables with descriptions. Reference also WCHQ Measure Spec Code List.xls TABLE O-1: Office Visit Encounter Codes CPT Codes Description Office or OP a visit E&M b, new patient Office or OP visit E&M, established patient Office or other OP consultations Home visit for evaluation and management of an established patient Initial preventive medicine E&M b Initial comprehensive preventive medicine E&M, infant age younger than 1 year Initial comprehensive preventive medicine E&M, early childhood, age 1-4 years Initial comprehensive preventive medicine E&M, late childhood, age 5-11 years Periodic comprehensive preventive medicine, established patient, infant age younger than 1 year Periodic comprehensive preventive medicine E&M, established patient, early childhood, age 1-4 years Periodic comprehensive preventive medicine, established patient, late childhood, age 5-11 years Periodic preventive medicine E&M b Preventive medicine counseling Preventive medicine counseling, group Preventive medicine counseling, group Risk assessment, admin and interpretation Unlisted preventive medicine service Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center (Deleted 01/01/15) Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with one faceto-face visit, per calendar month Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: Multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient; Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; Comprehensive care plan established, implemented, revised or monitored Transitional Care Management Services (Moderate Complexity) Transitional Care Management Services (High Complexity) HCPCS Code G0402 (Effective 01/01/09) G0438 G0439 Description Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment Annual wellness visit; includes a personalized prevention plan of service, initial visit Annual wellness visit; includes a personalized prevention plan of service, 9

10 subsequent visit a outpatient b evaluation and management WCHQ Ambulatory Measure Specification TABLE O-2: Codes to Identify Bone Densitometry Testing CPT Code (effective 01/01/07 replaced by 77078) (effective 01/01/07 replaced by 77079) (effective 01/01/07 replaced by 77080) (effective 01/01/07 replaced by 77081) 76077(effective 01/01/07 replaced by 77082) (deleted 01/01/07) Description Computerized tomography bone mineral density study, one or more sites; axial skeleton Computerized tomography bone mineral density study, one or more sites; appendicular skeleton Dual energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton Dual energy x-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessment Radiographic absorptiometry, 1 or more sites Ultrasound Bone Density Measurement and Interpretation, peripheral site(s), any method Computed Tomography, bone mineral density study, 1 or more sites; axial skeleton Computed Tomography, bone mineral density study, 1 or more sites; appendicular skeleton Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessment Radiographic absorptiometry, 1 or more sites DXA Bone Density Study Axial Skeleton Bone Density (Bone mineral content) Study, 1 or more sites; single photon absorptiometry Bone Density (Bone mineral content) Study, 1 or more sites; dual photon absorptiometry 0028T Dual Energy X-Ray Absorptiometry (DEXA) body composition study HCPCS Codes G0130 Description Single energy x-ray absorptiometry (SEXA) bone density study) 10

11 G0131 (replaced by CPT and 77078) G0132 (replaced by CPT and 77079) G0062 (deleted 04/1998) G0063 (deleted 04/1998) G9769 ICD-9 CM Diagnosis Code *V82.81 Computerized tomography bone mineral density study, 1 or more sites; axial skeleton Computerized tomography bone mineral density study, 1 or more sites; appendicular skeleton Peripheral skeletal bone mineral density studies (e.g., radius, wrist, and heel) Central skeletal bone mineral density studies (e.g., spine, pelvis). Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months Description Special Screening for Osteoporosis *Code can be included at the organization s discretion. If included, chart review is required for these visits. Effective 10/01/2015 ICD-10 CM Diagnosis Codes *Z Description Encounter for screening for osteoporosis *Code can be included at the organization s discretion. If included, chart review is required for these visits. ICD-9 CM Procedure Code Description Bone Densitometry Effective 10/01/2015 ICD-10 PCS Procedure Codes BP48ZZ1 BP49ZZ1 BP4GZZ1 BP4HZZ1 BP4LZZ1 BP4MZZ1 BP4NZZ1 BP4PZZ1 BQ00ZZ1 BQ01ZZ1 BQ03ZZ1 BQ04ZZ1 Description Ultrasonography of Right Shoulder, Densitometry Ultrasonography of Left Shoulder, Densitometry Ultrasonography of Right Elbow, Densitometry Ultrasonography of Left Elbow, Densitometry Ultrasonography of Right Wrist, Densitometry Ultrasonography of Left Wrist, Densitometry Ultrasonography of Right Hand, Densitometry Ultrasonography of Left Hand, Densitometry Plain Radiography of Right Hip, Densitometry Plain Radiography of Left Hip, Densitometry Plain Radiography of Right Femur, Densitometry Plain Radiography of Left Femur, Densitometry 11

12 BR00ZZ1 BR07ZZ1 BR09ZZ1 BR0GZZ1 Plain Radiography of Cervical Spine, Densitometry Plain Radiography of Thoracic Spine, Densitometry Plain Radiography of Lumbar Spine, Densitometry Plain Radiography of Whole Spine, Densitometry TABLE O-3: Codes to Identify Osteoporosis and Osteopenia ICD-9 CM Description Diagnosis Code 733.0X Osteoporosis Osteoporosis, unspecified Senile Osteoporosis Idiopathic Osteoporosis Disuse Osteoporosis Other Osteoporosis Osteopenia (disorder of bone and cartilage unspecified) Effective 10/01/2015 ICD-10 CM Diagnosis Codes M80.00XA M80.00XD M80.00XG M80.00XK M80.00XP M80.00XS M80.011A M80.011D M80.011G M80.011K M80.011P M80.011S M80.012A M80.012D M80.012G M80.012K Description Osteoporosis with pathological fracture Age-related osteoporosis with current pathological fracture with routine healing Age-related osteoporosis with current pathological fracture with delayed healing Age-related osteoporosis with current pathological fracture with nonunion Age-related osteoporosis with current pathological fracture with malunion site, Age-related osteoporosis with current pathological fracture of right shoulder Age-related osteoporosis with current pathological fracture of right shoulder with routine healing Age-related osteoporosis with current pathological fracture of right shoulder with delayed healing Age-related osteoporosis with current pathological fracture of right shoulder with nonunion Age-related osteoporosis with current pathological fracture of right shoulder with malunion Age-related osteoporosis with current pathological fracture, right shoulder, Age-related osteoporosis with current pathological fracture of left shoulder Age-related osteoporosis with current pathological fracture of left shoulder with routine healing Age-related osteoporosis with current pathological fracture of left shoulder with delayed healing Age-related osteoporosis with current pathological fracture of left shoulder with nonunion 12

13 M80.012P M80.012S M80.019A M80.019D M80.019G M80.019K M80.019P M80.019S M80.021A M80.021D M80.021G M80.021K M80.021P M80.021S M80.022A M80.022D M80.022G M80.022K M80.022P M80.022S M80.029A M80.029D M80.029G M80.029K M80.029P M80.029S Age-related osteoporosis with current pathological fracture of left shoulder with malunion Age-related osteoporosis with current pathological fracture, left shoulder, Osteoporosis with pathological fracture of shoulder region Age-related osteoporosis with current pathological fracture of shoulder with routine healing Age-related osteoporosis with current pathological fracture of shoulder with delayed healing Age-related osteoporosis with current pathological fracture of shoulder with nonunion Age-related osteoporosis with current pathological fracture of shoulder with malunion shoulder, Age-related osteoporosis with current pathological fracture of right humerus Age-related osteoporosis with current pathological fracture of right humerus with routine healing Age-related osteoporosis with current pathological fracture of right humerus with delayed healing Age-related osteoporosis with current pathological fracture of right humerus with nonunion Age-related osteoporosis with current pathological fracture of right humerus with malunion Age-related osteoporosis with current pathological fracture, right humerus, Age-related osteoporosis with current pathological fracture of left humerus Age-related osteoporosis with current pathological fracture of left humerus with routine healing Age-related osteoporosis with current pathological fracture of left humerus with delayed healing Age-related osteoporosis with current pathological fracture of left humerus with nonunion Age-related osteoporosis with current pathological fracture of left humerus with malunion Age-related osteoporosis with current pathological fracture, left humerus, Age-related osteoporosis with current pathological fracture of humerus Age-related osteoporosis with current pathological fracture of humerus with routine healing Age-related osteoporosis with current pathological fracture of humerus with delayed healing Age-related osteoporosis with current pathological fracture of humerus with nonunion Age-related osteoporosis with current pathological fracture of humerus with malunion humerus, 13

14 M80.031A M80.031D M80.031G M80.031K M80.031P M80.031S M80.032A M80.032D M80.032G M80.032K M80.032P M80.032S M80.039A M80.039D M80.039G M80.039K M80.039P M80.039S M80.041A M80.041D M80.041G M80.041K M80.041P M80.041S M80.042A M80.042D M80.042G Age-related osteoporosis with current pathological fracture of right forearm Age-related osteoporosis with current pathological fracture of right forearm with routine healing Age-related osteoporosis with current pathological fracture of right forearm with delayed healing Age-related osteoporosis with current pathological fracture of right forearm with nonunion Age-related osteoporosis with current pathological fracture of right forearm with malunion Age-related osteoporosis with current pathological fracture, right forearm, Age-related osteoporosis with current pathological fracture of left forearm Age-related osteoporosis with current pathological fracture of left forearm with routine healing Age-related osteoporosis with current pathological fracture of left forearm with delayed healing Age-related osteoporosis with current pathological fracture of left forearm with nonunion Age-related osteoporosis with current pathological fracture of left forearm with malunion Age-related osteoporosis with current pathological fracture, left forearm, Age-related osteoporosis with current pathological fracture of forearm Age-related osteoporosis with current pathological fracture of forearm with routine healing Age-related osteoporosis with current pathological fracture of forearm with delayed healing Age-related osteoporosis with current pathological fracture of forearm with nonunion Age-related osteoporosis with current pathological fracture of forearm with malunion forearm, Age-related osteoporosis with current pathological fracture of right hand Age-related osteoporosis with current pathological fracture of right hand with routine healing Age-related osteoporosis with current pathological fracture of right hand with delayed healing Age-related osteoporosis with current pathological fracture of right hand with nonunion Age-related osteoporosis with current pathological fracture of right hand with malunion Age-related osteoporosis with current pathological fracture, right hand, Age-related osteoporosis with current pathological fracture of left hand Age-related osteoporosis with current pathological fracture of left hand with routine healing Age-related osteoporosis with current pathological fracture of left hand with 14

15 M80.042K M80.042P M80.042S M80.049A M80.049D M80.049G M80.049K M80.049P M80.049S M80.051A M80.051D M80.051G M80.051K M80.051P M80.051S M80.052A M80.052D M80.052G M80.052K M80.052P M80.052S M80.059A M80.059D M80.059G M80.059K M80.059P delayed healing Age-related osteoporosis with current pathological fracture of left hand with nonunion Age-related osteoporosis with current pathological fracture of left hand with malunion Age-related osteoporosis with current pathological fracture, left hand, Age-related osteoporosis with current pathological fracture of hand Age-related osteoporosis with current pathological fracture of hand with routine healing Age-related osteoporosis with current pathological fracture of hand with delayed healing Age-related osteoporosis with current pathological fracture of hand with nonunion Age-related osteoporosis with current pathological fracture of hand with malunion hand, Age-related osteoporosis with current pathological fracture of right femur Age-related osteoporosis with current pathological fracture of right femur with routine healing Age-related osteoporosis with current pathological fracture of right femur with delayed healing Age-related osteoporosis with current pathological fracture of right femur with nonunion Age-related osteoporosis with current pathological fracture of right femur with malunion Age-related osteoporosis with current pathological fracture, right femur, Age-related osteoporosis with current pathological fracture of left femur Age-related osteoporosis with current pathological fracture of left femur with routine healing Age-related osteoporosis with current pathological fracture of left femur with delayed healing Age-related osteoporosis with current pathological fracture of left femur with nonunion Age-related osteoporosis with current pathological fracture of left femur with malunion Age-related osteoporosis with current pathological fracture, left femur, Osteoporotic hip fracture Age-related osteoporosis with current pathological fracture of femur with routine healing Age-related osteoporosis with current pathological fracture of femur with delayed healing Age-related osteoporosis with current pathological fracture of femur with nonunion Age-related osteoporosis with current pathological fracture of femur with 15

16 M80.059S M80.061A M80.061D M80.061G M80.061K M80.061P M80.061S M80.062A M80.062D M80.062G M80.062K M80.062P M80.062S M80.069A M80.069D M80.069G M80.069K M80.069P M80.069S M80.071A M80.071D M80.071G M80.071K M80.071P M80.071S malunion femur, Age-related osteoporosis with current pathological fracture of right lower leg Age-related osteoporosis with current pathological fracture of right lower leg with routine healing Age-related osteoporosis with current pathological fracture of right lower leg with delayed healing Age-related osteoporosis with current pathological fracture of right lower leg with nonunion Age-related osteoporosis with current pathological fracture of right lower leg with malunion Age-related osteoporosis with current pathological fracture, right lower leg, Age-related osteoporosis with current pathological fracture of left lower leg Age-related osteoporosis with current pathological fracture of left lower leg with routine healing Age-related osteoporosis with current pathological fracture of left lower leg with delayed healing Age-related osteoporosis with current pathological fracture of left lower leg with nonunion Age-related osteoporosis with current pathological fracture of left lower leg with malunion Age-related osteoporosis with current pathological fracture, left lower leg, Age-related osteoporosis with current pathological fracture of lower leg Age-related osteoporosis with current pathological fracture of lower leg with routine healing Age-related osteoporosis with current pathological fracture of lower leg with delayed healing Age-related osteoporosis with current pathological fracture of lower leg with nonunion Age-related osteoporosis with current pathological fracture of lower leg with malunion lower leg, Age-related osteoporosis with current pathological fracture, right ankle and foot, initial Age-related osteoporosis with current pathological fracture, right ankle and foot, Age-related osteoporosis with current pathological fracture, right ankle and foot, Age-related osteoporosis with current pathological fracture, right ankle and foot, Age-related osteoporosis with current pathological fracture, right ankle and foot, Age-related osteoporosis with current pathological fracture, right ankle and 16

17 M80.072A M80.072D M80.072G M80.072K M80.072P M80.072S M80.079A M80.079D M80.079G M80.079K M80.079P M80.079S M80.08XA M80.08XD M80.08XG M80.08XK M80.08XP M80.08XS M80.80XA M80.80XD M80.80XG M80.80XK M80.80XP M80.80XS M80.811A foot, Age-related osteoporosis with current pathological fracture, left ankle and foot, initial Age-related osteoporosis with current pathological fracture, left ankle and foot, Age-related osteoporosis with current pathological fracture, left ankle and foot, Age-related osteoporosis with current pathological fracture, left ankle and foot, Age-related osteoporosis with current pathological fracture, left ankle and foot, Age-related osteoporosis with current pathological fracture, left ankle and foot, Osteoporosis with pathological fracture of ankle and foot ankle and foot, ankle and foot, ankle and foot, ankle and foot, ankle and foot, Crush fracture of vertebra due to osteoporosis Age-related osteoporosis with current pathological fracture of vertebra with routine healing Age-related osteoporosis with current pathological fracture of vertebra with delayed healing Age-related osteoporosis with current pathological fracture of vertebra with nonunion Age-related osteoporosis with current pathological fracture of vertebra with malunion Age-related osteoporosis with current pathological fracture, vertebra(e), Osteoporosis with pathological fracture of multiple sites Other osteoporosis with current pathological fracture, unspecified site, Other osteoporosis with current pathological fracture, unspecified site, Other osteoporosis with current pathological fracture, unspecified site, Other osteoporosis with current pathological fracture, unspecified site, Other osteoporosis with current pathological fracture, unspecified site, Other osteoporosis with current pathological fracture, right shoulder, initial 17

18 M80.811D M80.811G M80.811K M80.811P M80.811S M80.812A M80.812D M80.812G M80.812K M80.812P M80.812S M80.819A M80.819D M80.819G M80.819K M80.819P M80.819S M80.821A M80.821D M80.821G M80.821K M80.821P M80.821S M80.822A M80.822D Other osteoporosis with current pathological fracture, right shoulder, Other osteoporosis with current pathological fracture, right shoulder, Other osteoporosis with current pathological fracture, right shoulder, Other osteoporosis with current pathological fracture, right shoulder, Other osteoporosis with current pathological fracture, right shoulder, Other osteoporosis with current pathological fracture, left shoulder, initial Other osteoporosis with current pathological fracture, left shoulder, Other osteoporosis with current pathological fracture, left shoulder, Other osteoporosis with current pathological fracture, left shoulder, Other osteoporosis with current pathological fracture, left shoulder, Other osteoporosis with current pathological fracture, left shoulder, Other osteoporosis with current pathological fracture, unspecified shoulder, initial Other osteoporosis with current pathological fracture, unspecified shoulder, Other osteoporosis with current pathological fracture, unspecified shoulder, Other osteoporosis with current pathological fracture, unspecified shoulder, Other osteoporosis with current pathological fracture, unspecified shoulder, Other osteoporosis with current pathological fracture, unspecified shoulder, Other osteoporosis with current pathological fracture, right humerus, initial Other osteoporosis with current pathological fracture, right humerus, Other osteoporosis with current pathological fracture, right humerus, Other osteoporosis with current pathological fracture, right humerus, Other osteoporosis with current pathological fracture, right humerus, Other osteoporosis with current pathological fracture, right humerus, Other osteoporosis with current pathological fracture, left humerus, initial Other osteoporosis with current pathological fracture, left humerus, 18

19 M80.822G M80.822K M80.822P M80.822S M80.829A M80.829D M80.829G M80.829K M80.829P M80.829S M80.831A M80.831D M80.831G M80.831K M80.831P M80.831S M80.832A M80.832D M80.832G M80.832K M80.832P M80.832S M80.839A M80.839D M80.839G Other osteoporosis with current pathological fracture, left humerus, Other osteoporosis with current pathological fracture, left humerus, Other osteoporosis with current pathological fracture, left humerus, Other osteoporosis with current pathological fracture, left humerus, Other osteoporosis with current pathological fracture, unspecified humerus, initial Other osteoporosis with current pathological fracture, unspecified humerus, Other osteoporosis with current pathological fracture, unspecified humerus, Other osteoporosis with current pathological fracture, unspecified humerus, Other osteoporosis with current pathological fracture, unspecified humerus, Other osteoporosis with current pathological fracture, unspecified humerus, Other osteoporosis with current pathological fracture, right forearm, initial Other osteoporosis with current pathological fracture, right forearm, Other osteoporosis with current pathological fracture, right forearm, Other osteoporosis with current pathological fracture, right forearm, Other osteoporosis with current pathological fracture, right forearm, Other osteoporosis with current pathological fracture, right forearm, Other osteoporosis with current pathological fracture, left forearm, initial Other osteoporosis with current pathological fracture, left forearm, Other osteoporosis with current pathological fracture, left forearm, Other osteoporosis with current pathological fracture, left forearm, Other osteoporosis with current pathological fracture, left forearm, Other osteoporosis with current pathological fracture, left forearm, Other osteoporosis with current pathological fracture, unspecified forearm, initial Other osteoporosis with current pathological fracture, unspecified forearm, Other osteoporosis with current pathological fracture, unspecified forearm, 19

20 M80.839K M80.839P M80.839S M80.841A M80.841D M80.841G M80.841K M80.841P M80.841S M80.842A M80.842D M80.842G M80.842K M80.842P M80.842S M80.849A M80.849D M80.849G M80.849K M80.849P M80.849S M80.851A M80.851D M80.851G M80.851K Other osteoporosis with current pathological fracture, unspecified forearm, Other osteoporosis with current pathological fracture, unspecified forearm, Other osteoporosis with current pathological fracture, unspecified forearm, Other osteoporosis with current pathological fracture, right hand, initial Other osteoporosis with current pathological fracture, right hand, Other osteoporosis with current pathological fracture, right hand, Other osteoporosis with current pathological fracture, right hand, Other osteoporosis with current pathological fracture, right hand, Other osteoporosis with current pathological fracture, right hand, Other osteoporosis with current pathological fracture, left hand, initial Other osteoporosis with current pathological fracture, left hand, subsequent with routine healing Other osteoporosis with current pathological fracture, left hand, subsequent with delayed healing Other osteoporosis with current pathological fracture, left hand, subsequent with nonunion Other osteoporosis with current pathological fracture, left hand, subsequent with malunion Other osteoporosis with current pathological fracture, left hand, Other osteoporosis with current pathological fracture, unspecified hand, initial Other osteoporosis with current pathological fracture, unspecified hand, Other osteoporosis with current pathological fracture, unspecified hand, Other osteoporosis with current pathological fracture, unspecified hand, Other osteoporosis with current pathological fracture, unspecified hand, Other osteoporosis with current pathological fracture, unspecified hand, Other osteoporosis with current pathological fracture, right femur, initial Other osteoporosis with current pathological fracture, right femur, Other osteoporosis with current pathological fracture, right femur, Other osteoporosis with current pathological fracture, right femur, 20

21 M80.851P M80.851S M80.852A M80.852D M80.852G M80.852K M80.852P M80.852S M80.859A M80.859D M80.859G M80.859K M80.859P M80.859S M80.861A M80.861D M80.861G M80.861K M80.861P M80.861S M80.862A M80.862D M80.862G M80.862K M80.862P Other osteoporosis with current pathological fracture, right femur, Other osteoporosis with current pathological fracture, right femur, Other osteoporosis with current pathological fracture, left femur, initial Other osteoporosis with current pathological fracture, left femur, Other osteoporosis with current pathological fracture, left femur, Other osteoporosis with current pathological fracture, left femur, Other osteoporosis with current pathological fracture, left femur, Other osteoporosis with current pathological fracture, left femur, Other osteoporosis with current pathological fracture, unspecified femur, initial Other osteoporosis with current pathological fracture, unspecified femur, Other osteoporosis with current pathological fracture, unspecified femur, Other osteoporosis with current pathological fracture, unspecified femur, Other osteoporosis with current pathological fracture, unspecified femur, Other osteoporosis with current pathological fracture, unspecified femur, Other osteoporosis with current pathological fracture, right lower leg, initial Other osteoporosis with current pathological fracture, right lower leg, Other osteoporosis with current pathological fracture, right lower leg, Other osteoporosis with current pathological fracture, right lower leg, Other osteoporosis with current pathological fracture, right lower leg, Other osteoporosis with current pathological fracture, right lower leg, Other osteoporosis with current pathological fracture, left lower leg, initial Other osteoporosis with current pathological fracture, left lower leg, Other osteoporosis with current pathological fracture, left lower leg, Other osteoporosis with current pathological fracture, left lower leg, Other osteoporosis with current pathological fracture, left lower leg, 21

22 M80.862S M80.869A M80.869D M80.869G M80.869K M80.869P M80.869S M80.871A M80.871D M80.871G M80.871K M80.871P M80.871S M80.872A M80.872D M80.872G M80.872K M80.872P M80.872S M80.879A M80.879D M80.879G M80.879K M80.879P Other osteoporosis with current pathological fracture, left lower leg, Other osteoporosis with current pathological fracture, unspecified lower leg, initial Other osteoporosis with current pathological fracture, unspecified lower leg, Other osteoporosis with current pathological fracture, unspecified lower leg, Other osteoporosis with current pathological fracture, unspecified lower leg, Other osteoporosis with current pathological fracture, unspecified lower leg, Other osteoporosis with current pathological fracture, unspecified lower leg, Other osteoporosis with current pathological fracture, right ankle and foot, initial Other osteoporosis with current pathological fracture, right ankle and foot, Other osteoporosis with current pathological fracture, right ankle and foot, Other osteoporosis with current pathological fracture, right ankle and foot, Other osteoporosis with current pathological fracture, right ankle and foot, Other osteoporosis with current pathological fracture, right ankle and foot, Other osteoporosis with current pathological fracture, left ankle and foot, initial Other osteoporosis with current pathological fracture, left ankle and foot, Other osteoporosis with current pathological fracture, left ankle and foot, Other osteoporosis with current pathological fracture, left ankle and foot, Other osteoporosis with current pathological fracture, left ankle and foot, Other osteoporosis with current pathological fracture, left ankle and foot, Other osteoporosis with current pathological fracture, unspecified ankle and foot, initial Other osteoporosis with current pathological fracture, unspecified ankle and foot, Other osteoporosis with current pathological fracture, unspecified ankle and foot, Other osteoporosis with current pathological fracture, unspecified ankle and foot, Other osteoporosis with current pathological fracture, unspecified ankle 22