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ICD-10 Guide
ICD-10 CodesM84.439

M84.439

Billable

Pathological fracture, unspecified ulna and radius

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M84.439 is a billable code used to indicate a diagnosis of pathological fracture, unspecified ulna and radius.

Key Diagnostic Point:

A pathological fracture of the ulna and radius occurs when these bones break due to underlying conditions that weaken bone structure, rather than from a direct trauma. This can be attributed to various bone density disorders, such as osteoporosis, which is characterized by reduced bone mass and deterioration of bone tissue, leading to increased fragility. Pathological fractures can also arise from metabolic bone diseases, malignancies, or chronic conditions that affect bone metabolism. Patients with osteoporosis are particularly at risk, as their bones lose density and strength over time, making them more susceptible to fractures even from minimal stress or injury. The ulna and radius are the two long bones of the forearm, and fractures in these areas can significantly impact a patient's mobility and quality of life. Diagnosis typically involves imaging studies, such as X-rays, to confirm the fracture and assess the extent of bone loss. Treatment may include pain management, stabilization of the fracture, and addressing the underlying bone density disorder to prevent future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of underlying conditions
  • Need for precise identification of fracture location
  • Differentiation between traumatic and pathological fractures
  • Potential for multiple comorbidities affecting bone health

Audit Risk Factors

  • Inadequate documentation of underlying bone disorders
  • Failure to specify the type of fracture
  • Misclassification of traumatic versus pathological fractures
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, treatment plans, and follow-up notes are essential for accurate coding.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, or with a history of osteoporosis or other metabolic bone diseases.

Billing Considerations

Orthopedic specialists must ensure that all relevant comorbidities are documented to support the diagnosis of a pathological fracture.

Endocrinology

Documentation Requirements

Documentation of bone density tests, metabolic evaluations, and treatment plans for osteoporosis or other metabolic disorders.

Common Clinical Scenarios

Patients with osteoporosis presenting with fractures, or those undergoing treatment for metabolic bone diseases.

Billing Considerations

Endocrinologists should document the patient's bone health status and any treatments that may affect fracture risk.

Coding Guidelines

Inclusion Criteria

Use M84.439 When
  • According to ICD
  • 10 guidelines, M84
  • 439 should be used when the fracture is confirmed as pathological and the specific type of fracture is not documented
  • Coders should ensure that the underlying condition contributing to the fracture is also coded appropriately

Exclusion Criteria

Do NOT use M84.439 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20605CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used in conjunction with M84.439 when joint aspiration is needed due to swelling from the fracture.

Documentation Requirements

Document the reason for aspiration and findings during the procedure.

Specialty Considerations

Orthopedic specialists should ensure that the aspiration is clearly linked to the fracture diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, including the ability to differentiate between traumatic and pathological fractures, which enhances the accuracy of patient records and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the ability to differentiate between traumatic and pathological fractures, which enhances the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, including the ability to differentiate between traumatic and pathological fractures, which enhances the accuracy of patient records and treatment plans.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between a pathological fracture and a traumatic fracture?

A pathological fracture occurs due to underlying bone disease or weakness, while a traumatic fracture results from an external force or injury.