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ICD-10 Guide
ICD-10 CodesM84.472

M84.472

Billable

Pathological fracture, left ankle

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

Code Description

ICD-10 M84.472 is a billable code used to indicate a diagnosis of pathological fracture, left ankle.

Key Diagnostic Point:

A pathological fracture of the left ankle refers to a break in the bone that occurs due to underlying bone density disorders, such as osteoporosis or other metabolic bone diseases, rather than from a traumatic injury. These fractures are often the result of weakened bone structure, which can be caused by various factors including age, hormonal changes, nutritional deficiencies, and certain medical conditions. In the case of osteoporosis, the bones lose density and strength, making them more susceptible to fractures even with minimal or no trauma. The left ankle, being a weight-bearing joint, is particularly vulnerable to such fractures. Clinical evaluation typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the extent of bone loss. Management may include pain control, immobilization, and addressing the underlying bone density issues through medications, lifestyle changes, and physical therapy. Understanding the etiology of the fracture is crucial for effective treatment and prevention of future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying conditions like osteoporosis.
  • Differentiation from traumatic fractures can be challenging.
  • Documentation must specify the cause of the fracture.
  • May involve multiple specialties for comprehensive care.

Audit Risk Factors

  • Inadequate documentation of the underlying condition.
  • Failure to specify the type of fracture (e.g., acute vs. pathological).
  • Misclassification of the fracture type.
  • Lack of follow-up documentation on 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, elderly patients with osteoporosis.

Billing Considerations

Ensure that the cause of the fracture is clearly documented to support the use of M84.472.

Endocrinology

Documentation Requirements

Bone density test results, hormonal assessments, and treatment history.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Documenting the patient's bone health status is critical for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M84.472 When
  • According to ICD
  • 10 coding guidelines, M84
  • 472 should be used when a fracture is confirmed to be pathological due to an underlying condition
  • Coders must ensure that the documentation supports the diagnosis of a pathological fracture and includes details about the underlying bone density disorder

Exclusion Criteria

Do NOT use M84.472 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 a patient with a pathological fracture requires joint aspiration.

Documentation Requirements

Document the reason for the procedure and the findings.

Specialty Considerations

Orthopedic specialists may frequently perform this procedure in conjunction with fracture management.

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 them. 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 them. This specificity aids in better patient management and resource allocation.

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, such as osteoporosis, while a traumatic fracture results from an external force or injury.