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ICD-10 Guide
ICD-10 CodesM84.512

M84.512

Billable

Pathological fracture in neoplastic disease, left shoulder

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

Code Description

ICD-10 M84.512 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, left shoulder.

Key Diagnostic Point:

A pathological fracture in neoplastic disease refers to a fracture that occurs in a bone weakened by the presence of a tumor, either benign or malignant. In this case, the fracture is specifically located in the left shoulder. Neoplastic diseases can lead to bone density disorders, such as osteoporosis, by disrupting normal bone metabolism and causing bone resorption to outpace formation. This imbalance can significantly weaken the structural integrity of bones, making them more susceptible to fractures even with minimal or no trauma. Patients with neoplastic diseases often experience pain, swelling, and reduced mobility in the affected area. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to confirm the presence of a fracture and assess the extent of bone involvement. Treatment may include pain management, stabilization of the fracture, and addressing the underlying neoplastic condition, which may involve chemotherapy, radiation, or surgical intervention. Proper coding is essential for accurate billing and to ensure that the patient's medical history reflects the complexity of their condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their impact on bone health.
  • Differentiation between primary and secondary neoplasms affecting the bone.
  • Need for precise documentation of fracture location and type.
  • Potential for multiple comorbidities that may complicate coding.

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease.
  • Failure to specify the exact location of the fracture.
  • Misclassification of the type of fracture (e.g., traumatic vs. pathological).
  • Lack of supporting imaging studies in the medical record.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of the neoplastic disease, treatment history, and imaging results.

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Ensure that the relationship between the neoplasm and the fracture is clearly documented.

Orthopedics

Documentation Requirements

Complete fracture assessment, including mechanism of injury and treatment plan.

Common Clinical Scenarios

Patients with fractures due to underlying malignancies requiring surgical intervention.

Billing Considerations

Document any surgical procedures performed and the rationale for intervention.

Coding Guidelines

Inclusion Criteria

Use M84.512 When
  • According to ICD
  • 10 coding guidelines, M84
  • 512 should be used when a pathological fracture is confirmed in a patient with a documented neoplastic disease
  • Coders must ensure that the neoplasm is specified and that the fracture is accurately described

Exclusion Criteria

Do NOT use M84.512 When
  • Exclusion criteria include fractures not related to neoplastic conditions

Related ICD-10 Codes

Related CPT Codes

20605CPT Code

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

Clinical Scenario

Used for pain management in patients with pathological fractures.

Documentation Requirements

Document the indication for the procedure and the patient's response.

Specialty Considerations

Orthopedic specialists may perform this procedure for symptomatic relief.

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

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.

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 in a bone weakened by disease, such as a neoplasm, while a traumatic fracture results from an external force or injury.