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ICD-10 Guide
ICD-10 CodesM84.532

M84.532

Billable

Pathological fracture in neoplastic disease, left ulna

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

Code Description

ICD-10 M84.532 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, left ulna.

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 left ulna, one of the two long bones in the forearm. 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 localized bone destruction, leading to a significant reduction in bone strength and an increased risk of fractures even with minimal or no trauma. Patients with such fractures often present with pain, swelling, and decreased function of 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, such as fixation or stabilization of the fracture, alongside treatment of the underlying neoplastic condition. Understanding the interplay 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 effects on bone health.
  • Involves understanding of pathological fractures versus traumatic fractures.
  • Documentation must specify the location and nature of the fracture.
  • Need to differentiate from other types of fractures and conditions.

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 imaging reports to support the diagnosis.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Need for clear documentation of the relationship between the neoplasm and the fracture.

Orthopedics

Documentation Requirements

Surgical notes, imaging results, and post-operative care details.

Common Clinical Scenarios

Fracture repair in patients with known malignancies affecting bone integrity.

Billing Considerations

Documentation must reflect the surgical approach and any complications related to the neoplastic disease.

Coding Guidelines

Inclusion Criteria

Use M84.532 When
  • According to ICD
  • 10 guidelines, M84
  • 532 should be used when a pathological fracture is confirmed in a patient with a documented neoplastic disease
  • It is essential to ensure that the fracture is not due to trauma and that the underlying condition is well
  • documented

Exclusion Criteria

Do NOT use M84.532 When
No specific exclusions found.

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.

Documentation Requirements

Document the reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on the patient's condition.

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