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ICD-10 Guide
ICD-10 CodesM84.521

M84.521

Billable

Pathological fracture in neoplastic disease, right humerus

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

Code Description

ICD-10 M84.521 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, right humerus.

Key Diagnostic Point:

A pathological fracture in the context of 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 right humerus. Neoplastic diseases can lead to bone density disorders, such as osteoporosis, by disrupting normal bone metabolism and remodeling processes. The presence of a tumor can cause local bone destruction, leading to a significant reduction in bone strength and an increased risk of fractures. Patients with such fractures often present with pain, swelling, and limited mobility in the affected arm. Diagnosis typically involves imaging studies, such as X-rays or MRI, to assess the extent of the fracture and the underlying neoplastic process. Treatment may include surgical intervention, such as fixation or stabilization of the fracture, alongside management of the neoplastic disease itself. Understanding the interplay between neoplastic conditions and bone health is crucial for effective treatment and rehabilitation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their effects on bone health.
  • Involves distinguishing between pathological and traumatic fractures.
  • Documentation must specify the location and nature of the fracture.
  • May require knowledge of concurrent conditions affecting bone density.

Audit Risk Factors

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

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of the type and stage of neoplasm, treatment history, and any related bone density assessments.

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Ensure that the neoplastic disease is clearly documented to support the use of M84.521.

Orthopedics

Documentation Requirements

Comprehensive notes on fracture assessment, treatment plans, and any surgical interventions performed.

Common Clinical Scenarios

Patients with fractures due to underlying bone metastases requiring surgical fixation.

Billing Considerations

Document the mechanism of injury and any pre-existing conditions affecting bone health.

Coding Guidelines

Inclusion Criteria

Use M84.521 When
  • According to ICD
  • 10 guidelines, M84
  • 521 should be used when a fracture is directly related to a neoplastic disease
  • Coders must ensure that the neoplasm is documented and that the fracture is confirmed through imaging

Exclusion Criteria

Do NOT use M84.521 When
  • Exclusion criteria include fractures not related to neoplastic conditions

Related ICD-10 Codes

Related CPT Codes

20670CPT 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 aspiration and the findings.

Specialty Considerations

Orthopedic specialists should ensure clear documentation of the fracture and any associated procedures.

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.