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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.542

M84.542

Billable

Pathological fracture in neoplastic disease, left hand

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

Code Description

ICD-10 M84.542 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, left hand.

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 or cancerous growth. In this case, the fracture is specifically located in the left hand. Neoplastic diseases can lead to bone density disorders, such as osteoporosis, where the integrity of the bone is compromised. This can happen due to direct invasion of the bone by a tumor, or as a result of systemic effects of cancer, including the release of osteoclast-activating factors that lead to increased bone resorption. Patients with neoplastic diseases often experience pain, swelling, and reduced function in the affected area. The diagnosis of a pathological fracture typically involves imaging studies, such as X-rays or MRIs, to confirm the fracture and assess the underlying bone condition. Management may include surgical intervention, pain management, and treatment of the underlying neoplastic disease. Accurate coding is essential for proper treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their effects on bone health.
  • Differentiation from other types of fractures, such as traumatic fractures.
  • Need for precise documentation of the location and nature of the fracture.
  • Potential for multiple underlying conditions affecting bone density.

Audit Risk Factors

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

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Need for collaboration with orthopedic specialists for fracture management.

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Management of fractures in patients with known malignancies.

Billing Considerations

Understanding the implications of the underlying neoplastic disease on fracture healing.

Coding Guidelines

Inclusion Criteria

Use M84.542 When
  • According to ICD
  • 10 coding guidelines, M84
  • 542 should be used when a pathological fracture is confirmed in a patient with a documented neoplastic disease
  • It is essential to include the specific site of the fracture and ensure that the underlying condition is well
  • documented

Exclusion Criteria

Do NOT use M84.542 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 associated with fractures.

Documentation Requirements

Document the reason for the procedure and the joint involved.

Specialty Considerations

Orthopedic specialists may perform this procedure for pain 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, improving the accuracy of data collection and reimbursement processes. M84.542 provides a clear distinction for fractures related to neoplastic diseases, which was less defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the accuracy of data collection and reimbursement processes. M84.542 provides a clear distinction for fractures related to neoplastic diseases, which was less defined in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. M84.542 provides a clear distinction for fractures related to neoplastic diseases, which was less defined in ICD-9.

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 underlying disease processes that weaken the bone, such as cancer, while a traumatic fracture results from an external force or injury.