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ICD-10 Guide
ICD-10 CodesM84.562

M84.562

Billable

Pathological fracture in neoplastic disease, left tibia

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

Code Description

ICD-10 M84.562 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, left tibia.

Key Diagnostic Point:

A pathological fracture in the context of neoplastic disease refers to a fracture that occurs in a bone weakened by the presence of a tumor. In this case, the fracture is located in the left tibia, which is the larger bone in the lower leg. Neoplastic diseases, such as primary bone tumors or metastatic cancers, can compromise bone integrity, leading to decreased bone density and increased susceptibility to fractures. Patients with conditions like osteoporosis or those undergoing treatments that affect bone metabolism, such as chemotherapy or corticosteroids, are at higher risk for such fractures. The clinical presentation may include localized pain, swelling, and inability to bear weight on the affected limb. Diagnosis typically involves imaging studies, such as X-rays or MRI, to assess the fracture and evaluate the underlying neoplastic process. Management may require surgical intervention, such as fixation or stabilization of the fracture, alongside treatment of the underlying neoplasm. Understanding the interplay between bone density disorders and neoplastic diseases is crucial for effective treatment and rehabilitation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their impact on bone health.
  • Involves differentiating between pathological and traumatic fractures.
  • Documentation must specify the location and nature of the fracture.
  • Need to consider the underlying neoplastic condition for accurate coding.

Audit Risk Factors

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

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Ensure that the neoplasm is clearly documented to support the diagnosis of a pathological fracture.

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients with fractures due to underlying bone metastases requiring surgical intervention.

Billing Considerations

Document the surgical approach and any fixation devices used.

Coding Guidelines

Inclusion Criteria

Use M84.562 When
  • According to ICD
  • 10 coding guidelines, M84
  • 562 should be used when a fracture is confirmed to be pathological due to a neoplastic disease
  • Coders must ensure that the underlying neoplasm is documented and that the fracture is not due to trauma

Exclusion Criteria

Do NOT use M84.562 When
  • Exclusion criteria include fractures that are purely traumatic in nature

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

Surgical notes detailing the procedure and any fixation devices used.

Specialty Considerations

Orthopedic documentation must clearly link the procedure to the underlying neoplastic 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 related to neoplastic diseases, improving the accuracy of claims and enhancing data collection for research and treatment outcomes.

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 claims and enhancing data collection for research and treatment outcomes.

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 claims and enhancing data collection for research and treatment outcomes.

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.