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ICD-10 Guide
ICD-10 CodesM84.531

M84.531

Billable

Pathological fracture in neoplastic disease, right ulna

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

Code Description

ICD-10 M84.531 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, right ulna.

Key Diagnostic Point:

A pathological fracture in the context of neoplastic disease occurs when a bone, weakened by the presence of a tumor, breaks under normal stress or minimal trauma. In this case, the fracture is specifically located in the right ulna, one of the two long bones in the forearm. Neoplastic diseases, which include both benign and malignant tumors, can lead to bone density disorders by disrupting normal bone metabolism and remodeling processes. The presence of a tumor can cause osteolysis, where bone tissue is destroyed, leading to weakened structural integrity and increased susceptibility to fractures. Patients with such fractures often present with pain, swelling, and limited mobility in the affected area. 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 neoplasm, which may involve chemotherapy or radiation therapy. Understanding the relationship between neoplastic disease and bone health is crucial for effective treatment and rehabilitation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires knowledge of neoplastic diseases and their impact on bone health.
  • Differentiation from other types of fractures, such as traumatic fractures.
  • Need for accurate documentation of the underlying neoplasm.
  • Potential for multiple coding scenarios depending on the presence of metastasis.

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease.
  • Failure to specify the location of the fracture accurately.
  • Misclassification of the fracture type (pathological vs. traumatic).
  • Lack of supporting imaging documentation.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of the neoplasm type, 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 documented.

Orthopedics

Documentation Requirements

Comprehensive assessment of the fracture, including imaging results and treatment plans.

Common Clinical Scenarios

Management of fractures in patients with known malignancies.

Billing Considerations

Documentation should reflect the impact of the neoplasm on bone integrity.

Coding Guidelines

Inclusion Criteria

Use M84.531 When
  • According to ICD
  • 10 coding guidelines, M84
  • 531 should be used when a pathological fracture is confirmed in a patient with a documented neoplastic disease
  • Coders must ensure that the neoplasm is clearly identified in the medical record, and any relevant imaging studies are included in the documentation

Exclusion Criteria

Do NOT use M84.531 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 in conjunction with M84.531 for pain management in patients with pathological fractures.

Documentation Requirements

Document the indication for the procedure and any imaging studies performed.

Specialty Considerations

Orthopedic specialists should ensure that the relationship between the fracture and the neoplasm is documented.

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 and to avoid denials.

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.