ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesM84.522

M84.522

Billable

Pathological fracture in neoplastic disease, left humerus

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

Code Description

ICD-10 M84.522 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, left humerus.

Key Diagnostic Point:

A pathological fracture in the context of neoplastic disease occurs when a bone breaks due to the weakening of the bone structure caused by a tumor. In this case, the fracture is specifically located in the left humerus. Neoplastic diseases, such as primary bone tumors or metastatic cancers, can lead to significant alterations in bone density and integrity. The presence of a tumor can disrupt normal bone metabolism, leading to osteolytic lesions that weaken the bone and increase the risk of fractures even with minimal or no trauma. Patients with such fractures often present with pain, swelling, and decreased mobility in the affected limb. Diagnosis typically involves imaging studies, such as X-rays or MRI, to assess the extent of the fracture and the underlying neoplastic process. Management may include surgical intervention, pain management, and treatment of the underlying malignancy. Understanding the relationship between neoplastic diseases 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.
  • Differentiation between primary and metastatic tumors affecting the humerus.
  • Need for precise documentation of the fracture's cause and location.
  • Potential for multiple comorbidities complicating the clinical picture.

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease.
  • Failure to specify the type of fracture (e.g., complete vs. incomplete).
  • Lack of imaging studies to support the diagnosis.
  • Misclassification of the fracture as traumatic rather than pathological.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients with metastatic breast cancer presenting with pathological fractures.

Billing Considerations

Need to document the type of cancer and its treatment history.

Orthopedics

Documentation Requirements

Clear description of the fracture type, location, and any surgical interventions performed.

Common Clinical Scenarios

Patients with primary bone tumors requiring surgical fixation of fractures.

Billing Considerations

Documentation of the patient's overall bone health and any pre-existing conditions.

Coding Guidelines

Inclusion Criteria

Use M84.522 When
  • According to ICD
  • 10 guidelines, M84
  • 522 should be used when a pathological fracture is confirmed in a patient with a documented neoplastic disease
  • It is essential to ensure that the neoplastic condition is clearly stated in the medical record to support the use of this code

Exclusion Criteria

Do NOT use M84.522 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20605CPT 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.

Documentation Requirements

Document the reason for aspiration and any findings.

Specialty Considerations

Orthopedic specialists may perform this procedure 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 pathological fractures related to neoplastic diseases, improving the accuracy of data collection and reimbursement processes.

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 data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 a disease process that weakens the bone, such as cancer, whereas a traumatic fracture results from an external force or injury.