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ICD-10 Guide
ICD-10 CodesM84.464

M84.464

Billable

Pathological fracture, left fibula

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

Code Description

ICD-10 M84.464 is a billable code used to indicate a diagnosis of pathological fracture, left fibula.

Key Diagnostic Point:

A pathological fracture of the left fibula occurs when the bone breaks due to underlying conditions that compromise its structural integrity, rather than from a direct trauma or injury. This type of fracture is often associated with bone density disorders such as osteoporosis, where the bone becomes porous and weak, increasing the risk of fractures even with minimal or no trauma. Pathological fractures can also result from conditions like metastatic cancer, osteogenesis imperfecta, or Paget's disease, which affect bone metabolism and strength. In the case of the left fibula, the fracture may lead to significant pain, swelling, and impaired mobility. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the extent of any underlying bone disease. Treatment may include pain management, immobilization, and addressing the underlying condition to prevent future fractures. Understanding the etiology of the fracture is crucial for effective management and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between traumatic and pathological fractures
  • Understanding the underlying conditions contributing to the fracture
  • Accurate documentation of the fracture location and type
  • Potential for multiple co-existing conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of the underlying bone disorder
  • Failure to specify the type of fracture (e.g., complete vs. incomplete)
  • Misclassification of the fracture as traumatic rather than pathological
  • Lack of imaging reports to support the diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, clinical notes on fracture assessment, and treatment plans.

Common Clinical Scenarios

Patients presenting with fractures due to osteoporosis or other metabolic bone diseases.

Billing Considerations

Ensure that the underlying condition is documented to support the diagnosis of a pathological fracture.

Endocrinology

Documentation Requirements

Documentation of bone density tests, metabolic assessments, and management of osteoporosis.

Common Clinical Scenarios

Patients with osteoporosis presenting with fractures or those undergoing treatment for bone density disorders.

Billing Considerations

Documenting the patient's history of bone density issues is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M84.464 When
  • According to ICD
  • 10 coding guidelines, M84
  • 464 should be used when a pathological fracture is confirmed and the left fibula is specifically affected
  • Coders must ensure that the underlying condition contributing to the fracture is also documented, as this may require additional codes
  • pathological causes

Exclusion Criteria

Do NOT use M84.464 When
  • Exclusion criteria include fractures resulting from trauma or other non

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

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

Clinical Scenario

Used when a patient with a pathological fracture requires joint aspiration due to swelling.

Documentation Requirements

Document the reason for the procedure, the joint involved, and any imaging performed.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on the patient's condition.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of pathological fractures, enabling better tracking of conditions like osteoporosis and their complications. M84.464 provides a clear distinction between traumatic and pathological fractures, improving 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 pathological fractures, enabling better tracking of conditions like osteoporosis and their complications. M84.464 provides a clear distinction between traumatic and pathological fractures, improving the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

reimbursement and to avoid denials.

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. Pathological fractures can happen with minimal or no trauma, often in bones weakened by conditions like osteoporosis.