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ICD-10 Guide
ICD-10 CodesM84.52

M84.52

Billable

Pathological fracture in neoplastic disease, humerus

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

Code Description

ICD-10 M84.52 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, humerus.

Key Diagnostic Point:

A pathological fracture in the humerus due to neoplastic disease occurs when a tumor, either benign or malignant, weakens the bone structure, leading to an increased risk of fracture even with minimal or no trauma. This condition is often seen in patients with primary bone tumors, metastatic cancer, or hematological malignancies that affect bone integrity. The humerus, being a long bone, is particularly susceptible to such fractures when neoplastic lesions invade the bone, disrupting normal bone metabolism and density. Patients may present with pain, swelling, or deformity in the arm, and imaging studies such as X-rays or MRIs are typically employed to confirm the diagnosis. Treatment may involve surgical intervention, such as stabilization or resection of the affected area, alongside oncological management of the underlying neoplastic disease. Understanding the interplay between bone density disorders, such as osteoporosis, and neoplastic diseases is crucial, as these conditions can exacerbate the risk of fractures, complicating patient management and recovery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary and secondary neoplastic diseases
  • Understanding the impact of bone density disorders on fracture risk
  • Accurate documentation of the site and nature of the fracture
  • Co-morbid conditions that may influence treatment and coding

Audit Risk Factors

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

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of the cancer diagnosis, treatment history, and any related complications.

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 established.

Orthopedics

Documentation Requirements

Comprehensive notes on the fracture type, treatment plan, and follow-up care.

Common Clinical Scenarios

Management of fractures in patients with known malignancies.

Billing Considerations

Document any surgical interventions and the rationale for treatment choices.

Coding Guidelines

Inclusion Criteria

Use M84.52 When
  • According to ICD
  • 10 guidelines, M84
  • 52 should be used when a pathological fracture is confirmed in a patient with a documented neoplastic disease
  • Coders must ensure that the underlying condition is clearly stated in the medical record to support the use of this code

Exclusion Criteria

Do NOT use M84.52 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 due to swelling.

Documentation Requirements

Document the reason for the procedure and any 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 related to neoplastic diseases, improving the accuracy of patient records and facilitating better management of these complex cases.

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 management of these complex cases.

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 M84.52 and S42.2?

M84.52 is specifically for pathological fractures due to neoplastic disease, while S42.2 is for traumatic fractures of the humerus. Accurate documentation is crucial to determine the correct code.