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ICD-10 Guide
ICD-10 CodesM84.5

M84.5

Billable

Pathological fracture in neoplastic disease

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

Code Description

ICD-10 M84.5 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease.

Key Diagnostic Point:

Pathological fractures in neoplastic disease occur when a bone breaks due to the weakening of the bone structure caused by a tumor, either benign or malignant. These fractures are often associated with conditions such as metastatic cancer, where cancer cells spread to the bone, leading to bone destruction and decreased structural integrity. Patients with primary bone tumors, such as osteosarcoma or multiple myeloma, are also at risk. The fractures can occur with minimal or no trauma, distinguishing them from typical fractures. The clinical presentation may include localized pain, swelling, and decreased mobility. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to assess the extent of the fracture and the underlying neoplastic process. Management may involve surgical intervention, radiation therapy, or pharmacological treatment to strengthen bone density and manage pain. Understanding the relationship between neoplastic diseases and bone metabolism is crucial for effective treatment and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary and secondary neoplastic diseases
  • Identifying the specific type of fracture and its relation to the neoplasm
  • Documenting the patient's history of cancer and treatment
  • Understanding the implications of bone density disorders in fracture risk

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease
  • Failure to specify the type of fracture
  • Lack of imaging studies to support the diagnosis
  • Misclassification of the fracture type or cause

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of cancer diagnosis, treatment history, and current status.

Common Clinical Scenarios

Patients presenting with fractures during or after cancer treatment.

Billing Considerations

Ensure clear documentation of the relationship between the neoplasm and the fracture.

Orthopedics

Documentation Requirements

Comprehensive assessment of fracture type, location, and treatment plan.

Common Clinical Scenarios

Management of fractures in patients with known malignancies.

Billing Considerations

Document the impact of the neoplasm on bone health and fracture risk.

Coding Guidelines

Inclusion Criteria

Use M84.5 When
  • According to ICD
  • 10 guidelines, M84
  • 5 should be used when a pathological fracture is directly linked to a neoplastic disease
  • Coders must ensure that the underlying neoplasm is documented and that the fracture is not due to other causes such as trauma or osteoporosis alone

Exclusion Criteria

Do NOT use M84.5 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 in conjunction with M84.5 for pain management in patients with pathological fractures.

Documentation Requirements

Document the indication for the procedure and the patient's fracture history.

Specialty Considerations

Orthopedic specialists should ensure that the fracture's impact on joint function is noted.

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 related to neoplastic diseases, improving the accuracy of patient records and facilitating better treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures related to neoplastic diseases, improving the accuracy of patient records and facilitating better treatment planning.

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 underlying disease processes, such as neoplastic disease, that weaken the bone, while a traumatic fracture results from an external force or injury.