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ICD-10 Guide
ICD-10 CodesM84.550

M84.550

Billable

Pathological fracture in neoplastic disease, pelvis

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

Code Description

ICD-10 M84.550 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, pelvis.

Key Diagnostic Point:

A pathological fracture in the pelvis due to neoplastic disease occurs when a tumor, either benign or malignant, weakens the bone structure, leading to an increased risk of fracture. This condition is often seen in patients with primary bone cancers, metastatic cancers, or hematological malignancies that affect bone density and integrity. The pelvis is a common site for such fractures due to its weight-bearing function and the stress it endures during daily activities. Patients may present with pain, swelling, and limited mobility. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to assess the extent of the fracture and the underlying neoplastic process. Management may include pain control, stabilization of the fracture, and treatment of the underlying malignancy, which may involve surgery, radiation, or chemotherapy. Understanding the interplay between bone metabolism, tumor activity, and fracture risk is crucial for effective treatment and rehabilitation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary and secondary neoplastic diseases
  • Understanding the implications of bone density disorders on fracture risk
  • Identifying the specific site of the fracture within the pelvis
  • Documenting the underlying neoplastic condition accurately

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease
  • Failure to specify the type of fracture
  • Misclassification of the fracture site
  • Lack of clarity on the relationship between the neoplasm and the fracture

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of the neoplastic disease, including type, stage, and treatment history.

Common Clinical Scenarios

Patients with metastatic cancer presenting with pelvic 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

Patients with pathological fractures requiring surgical intervention.

Billing Considerations

Document the impact of the neoplastic disease on bone integrity and healing potential.

Coding Guidelines

Inclusion Criteria

Use M84.550 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the neoplastic disease and its relationship to the fracture
  • Include any relevant imaging studies and treatment plans in the medical record

Exclusion Criteria

Do NOT use M84.550 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27245CPT Code

Open treatment of pelvic fracture

Clinical Scenario

Used when surgical intervention is required for a pathological fracture.

Documentation Requirements

Surgical notes detailing the procedure and indication.

Specialty Considerations

Orthopedic surgeons must document the relationship between the fracture and the neoplastic disease.

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 management of these complex cases.

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 management of these complex cases.

Reimbursement & Billing Impact

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 management of these complex cases.

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 cancer, while a traumatic fracture results from an external force or injury.