ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesM84.471

M84.471

Billable

Pathological fracture, right ankle

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

Code Description

ICD-10 M84.471 is a billable code used to indicate a diagnosis of pathological fracture, right ankle.

Key Diagnostic Point:

A pathological fracture of the right ankle occurs when a bone breaks in response to minimal or no trauma due to an underlying condition that weakens the bone structure. This can be attributed to various bone density disorders, including osteoporosis, which is characterized by decreased bone mass and deterioration of bone tissue, leading to increased fragility and susceptibility to fractures. Pathological fractures are often seen in patients with chronic conditions such as malignancies, metabolic bone diseases, or prolonged corticosteroid use. In the case of the right ankle, the fracture may involve the fibula, tibia, or both, and can 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 the underlying bone density disorder. Treatment may include immobilization, pain management, and addressing the underlying condition to prevent future fractures. Understanding the relationship between bone metabolism and fracture risk is crucial for effective management and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate documentation of underlying bone density disorders.
  • Differentiation between traumatic and pathological fractures.
  • Potential for multiple underlying conditions contributing to fracture risk.
  • Variability in treatment approaches based on patient history and comorbidities.

Audit Risk Factors

  • Inadequate documentation of the underlying bone density disorder.
  • Failure to specify the type of fracture (e.g., complete vs. incomplete).
  • Misclassification of the fracture as traumatic rather than pathological.
  • Lack of follow-up documentation regarding treatment and outcomes.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, treatment plans, and follow-up notes.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, especially in older adults.

Billing Considerations

Documentation must clearly indicate the cause of the fracture and any underlying conditions.

Endocrinology

Documentation Requirements

Bone density test results, history of osteoporosis or other metabolic bone diseases.

Common Clinical Scenarios

Patients with osteoporosis experiencing fractures.

Billing Considerations

Documentation should include details on management of the underlying bone density disorder.

Coding Guidelines

Inclusion Criteria

Use M84.471 When
  • According to ICD
  • 10 coding guidelines, M84
  • 471 should be used when a pathological fracture is confirmed, and the underlying condition is documented
  • It is essential to ensure that the fracture is not due to trauma and that the patient's medical history supports the diagnosis of a bone density disorder

Exclusion Criteria

Do NOT use M84.471 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

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

Clinical Scenario

Used when joint aspiration is performed due to swelling from a fracture.

Documentation Requirements

Document the reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on clinical findings.

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, improving the ability to capture the complexity of these cases and the underlying conditions that contribute to fracture risk. This specificity aids in better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the ability to capture the complexity of these cases and the underlying conditions that contribute to fracture risk. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

reimbursement.

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 weakened bone structure from underlying conditions, while a traumatic fracture results from an external force or injury.