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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.552

M84.552

Billable

Pathological fracture in neoplastic disease, left femur

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

Code Description

ICD-10 M84.552 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, left femur.

Key Diagnostic Point:

A pathological fracture in the left femur due to neoplastic disease occurs when a tumor, either benign or malignant, weakens the bone structure, leading to an increased risk of fracture even with minimal or no trauma. This condition is often seen in patients with metastatic cancer, where cancer cells spread to the bone, disrupting normal bone metabolism and density. The weakened bone may not withstand normal forces, resulting in a fracture. Patients may present with pain, swelling, and decreased mobility in the affected limb. 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. Treatment may include surgical intervention, such as fixation or stabilization of the fracture, alongside management of the underlying cancer. Understanding the relationship between neoplastic disease and bone health is crucial, as conditions like osteoporosis can further complicate the management of fractures in these patients.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their effects on bone health.
  • Differentiation between primary and secondary bone tumors.
  • Need for accurate documentation of the fracture's cause and location.
  • Potential for multiple comorbidities affecting bone density.

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease.
  • Failure to specify the type of fracture (e.g., acute vs. chronic).
  • Lack of imaging reports to support the diagnosis.
  • Misclassification of the fracture type.

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 breast cancer presenting with femoral fractures.

Billing Considerations

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

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients requiring surgical intervention for femoral fractures due to underlying malignancies.

Billing Considerations

Document the surgical approach and any complications related to the neoplastic disease.

Coding Guidelines

Inclusion Criteria

Use M84.552 When
  • Follow ICD
  • CM guidelines for coding pathological fractures, ensuring that the underlying neoplastic disease is documented
  • Include any relevant imaging studies and treatment plans in the patient's medical record

Exclusion Criteria

Do NOT use M84.552 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27447CPT Code

Open treatment of femoral fracture

Clinical Scenario

Used when surgical intervention is required for a pathological fracture.

Documentation Requirements

Operative report detailing the procedure and indication for surgery.

Specialty Considerations

Orthopedic surgeons should document the relationship between the fracture and the underlying 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 data accuracy and enhancing the ability to track treatment outcomes and resource utilization.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures related to neoplastic diseases, improving data accuracy and enhancing the ability to track treatment outcomes and resource utilization.

Reimbursement & Billing Impact

reimbursement and to avoid claim 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 due to an underlying disease process, such as cancer, that weakens the bone, while a traumatic fracture results from an external force or injury.