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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.539

M84.539

Billable

Pathological fracture in neoplastic disease, unspecified ulna and radius

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

Code Description

ICD-10 M84.539 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, unspecified ulna and radius.

Key Diagnostic Point:

Pathological fractures occur when bones weaken due to underlying conditions, such as neoplastic diseases, which include various types of cancers. In this case, the fracture affects the ulna and radius, two long bones in the forearm. These fractures are often the result of bone metastasis, where cancer cells spread to the bone, leading to decreased bone density and structural integrity. Patients with neoplastic diseases may experience pain, swelling, and limited mobility in the affected area. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the presence of a fracture and assess the extent of bone involvement. Treatment may include pain management, stabilization of the fracture, and addressing the underlying neoplastic condition through chemotherapy, radiation, or surgical intervention. Understanding the relationship between bone metabolism, cancer, and fractures is crucial for effective management and coding of these complex cases.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of neoplastic disease types
  • Need for precise localization of fractures
  • Differentiation from other fracture types
  • Potential for multiple underlying conditions

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease
  • Failure to specify the fracture location
  • Lack of imaging reports to support the diagnosis
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of the cancer type, stage, and treatment history is essential.

Common Clinical Scenarios

Patients with metastatic bone disease presenting with fractures.

Billing Considerations

Ensure that the relationship between the neoplasm and the fracture is clearly documented.

Orthopedics

Documentation Requirements

Comprehensive notes on fracture assessment, treatment plans, and follow-up care.

Common Clinical Scenarios

Management of fractures in patients with known malignancies.

Billing Considerations

Document the mechanism of injury and any surgical interventions performed.

Coding Guidelines

Inclusion Criteria

Use M84.539 When
  • Follow the official ICD
  • CM guidelines for coding neoplastic diseases and pathological fractures
  • Ensure that the documentation supports the diagnosis and that the fracture is directly linked to the neoplastic condition

Exclusion Criteria

Do NOT use M84.539 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 managing joint pain related to fractures.

Documentation Requirements

Document the reason for the procedure and the patient's clinical history.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between the procedure and the underlying 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, improving the ability to capture the complexity of cases involving neoplastic diseases. This specificity aids in better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the ability to capture the complexity of cases involving neoplastic diseases. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the ability to capture the complexity of cases involving neoplastic diseases. This specificity aids in better patient management and resource allocation.

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 documentation is needed to support the use of M84.539?

Documentation must include the diagnosis of the neoplastic disease, details of the fracture, imaging results, and any treatment provided. Clear linkage between the fracture and the underlying condition is essential.