ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesM84.561

M84.561

Billable

Pathological fracture in neoplastic disease, right tibia

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

Code Description

ICD-10 M84.561 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, right tibia.

Key Diagnostic Point:

A pathological fracture in the context of neoplastic disease occurs when a bone breaks due to the weakening of its structure from cancerous growths. In this case, the fracture is located in the right tibia, which is the larger bone in the lower leg. Neoplastic diseases, such as primary bone tumors or metastatic cancers, can lead to significant alterations in bone density and integrity, making bones more susceptible to fractures even with minimal or no trauma. The presence of a tumor can disrupt normal bone metabolism, leading to osteolytic lesions that weaken the bone. Patients with such fractures often present with pain, swelling, and impaired 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. Treatment may include surgical intervention, such as fixation or stabilization of the fracture, alongside management of the underlying cancer. Understanding the relationship between neoplastic diseases and bone health is crucial for effective treatment and rehabilitation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their effects on bone health.
  • Involves differentiating between pathological and traumatic fractures.
  • Documentation must clearly indicate the neoplastic disease affecting the bone.
  • May require additional codes for the underlying neoplasm.

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease.
  • Failure to specify the location of the fracture accurately.
  • Misuse of the code for non-pathological fractures.
  • Lack of imaging studies to support the diagnosis.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of the type and stage of neoplastic disease, imaging results, and treatment plans.

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Ensure that the relationship between the neoplasm and the fracture is clearly established in the medical record.

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients with fractures due to underlying malignancies requiring surgical intervention.

Billing Considerations

Document the mechanism of injury and any relevant history of cancer treatment.

Coding Guidelines

Inclusion Criteria

Use M84.561 When
  • According to ICD
  • 10 guidelines, M84
  • 561 should be used when a fracture is confirmed to be pathological due to a neoplastic condition
  • Coders must ensure that the underlying neoplasm is documented and that the fracture is not due to trauma
  • The code should be supported by imaging and clinical findings

Exclusion Criteria

Do NOT use M84.561 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27506CPT Code

Open treatment of tibial fracture

Clinical Scenario

Used when surgical intervention is required for a pathological fracture.

Documentation Requirements

Operative reports detailing the procedure and indication for surgery.

Specialty Considerations

Orthopedic surgeons must document the relationship between the fracture and the underlying neoplasm.

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 data collection and reimbursement processes. This specificity helps in understanding the impact of cancer on bone health and guides treatment decisions.

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 data collection and reimbursement processes. This specificity helps in understanding the impact of cancer on bone health and guides treatment decisions.

Reimbursement & Billing Impact

reimbursement processes. This specificity helps in understanding the impact of cancer on bone health and guides treatment decisions.

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 weakened bone structure from disease processes, such as cancer, while a traumatic fracture results from an external force or injury.