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ICD-10 Guide
ICD-10 CodesM84.474

M84.474

Billable

Pathological fracture, right foot

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

Code Description

ICD-10 M84.474 is a billable code used to indicate a diagnosis of pathological fracture, right foot.

Key Diagnostic Point:

A pathological fracture of the right foot refers to a break in the bone that occurs due to underlying conditions that weaken the bone structure, rather than from a direct trauma or injury. This type of fracture is often associated with bone density disorders such as osteoporosis, which is characterized by decreased bone mass and deterioration of bone tissue, leading to increased fragility. In patients with osteoporosis, even minor stress or falls can result in fractures. The right foot can be affected by various types of fractures, including those of the metatarsals, phalanges, or tarsal bones. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the extent of bone loss. Treatment may include pain management, immobilization, and addressing the underlying bone density disorder through medications like bisphosphonates or calcium and vitamin D supplementation. Understanding the etiology of the fracture is crucial for effective management and prevention of future fractures, particularly in populations at risk, such as postmenopausal women and the elderly.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between traumatic and pathological fractures
  • Understanding the underlying conditions contributing to bone fragility
  • Accurate documentation of the fracture location and type
  • Co-morbidities that may affect treatment and coding

Audit Risk Factors

  • Inadequate documentation of the underlying bone density disorder
  • Failure to specify the exact location of the fracture
  • Misclassification of the fracture type (pathological vs. traumatic)
  • Lack of supporting imaging documentation

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, fracture location, and treatment plan.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, elderly patients with osteoporosis.

Billing Considerations

Ensure that the underlying conditions are documented to support the diagnosis of a pathological fracture.

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients with a history of fractures and diagnosed osteoporosis.

Billing Considerations

Documenting the management of osteoporosis is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M84.474 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the fracture is documented as pathological and that any underlying conditions are noted
  • Include any relevant imaging studies and treatment plans in the documentation

Exclusion Criteria

Do NOT use M84.474 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 needed due to swelling from a fracture.

Documentation Requirements

Document the reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists may perform this procedure frequently 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 fractures, including the distinction between traumatic and pathological fractures, which aids in better tracking and management of conditions like osteoporosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the distinction between traumatic and pathological fractures, which aids in better tracking and management of conditions like osteoporosis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, including the distinction between traumatic and pathological fractures, which aids in better tracking and management of conditions like osteoporosis.

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.