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ICD-10 Guide
ICD-10 CodesM84.572

M84.572

Billable

Pathological fracture in neoplastic disease, left ankle

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

Code Description

ICD-10 M84.572 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, left ankle.

Key Diagnostic Point:

A pathological fracture in neoplastic disease occurs when a bone breaks due to the weakening of the bone structure caused by a tumor or cancerous growth. In the case of M84.572, the fracture specifically affects the left ankle. Neoplastic diseases can lead to changes in bone metabolism, resulting in decreased bone density and structural integrity. This can be due to primary bone tumors or metastatic lesions from other cancers, which can invade the bone and disrupt normal bone remodeling processes. Patients with such fractures often present with pain, swelling, and limited mobility in the affected area. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the extent of the underlying neoplastic disease. Management may include surgical intervention, pain management, and treatment 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.
  • Differentiation between pathological fractures and traumatic fractures.
  • Need for accurate documentation of the underlying neoplastic condition.
  • Potential for multiple codes related to the neoplasm and fracture.

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 documentation of the cancer diagnosis, treatment history, and any imaging studies.

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Ensure that the neoplasm is coded accurately to reflect the primary site and any metastases.

Orthopedics

Documentation Requirements

Comprehensive notes on the fracture type, treatment plan, and follow-up care.

Common Clinical Scenarios

Management of fractures in patients with known malignancies.

Billing Considerations

Coordination with oncology for comprehensive patient management.

Coding Guidelines

Inclusion Criteria

Use M84.572 When
  • According to ICD
  • 10 coding guidelines, M84
  • 572 should be used when a pathological fracture is confirmed in a patient with a neoplastic disease
  • Coders must ensure that the underlying neoplasm is documented and coded appropriately

Exclusion Criteria

Do NOT use M84.572 When
  • Exclusion criteria include fractures that are not related to neoplastic disease

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used for joint pain management in patients with fractures.

Documentation Requirements

Document the reason for the procedure and the joint involved.

Specialty Considerations

Orthopedic specialists may perform this procedure for pain relief.

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 patient care management.

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 patient care management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pathological fractures related to neoplastic diseases, improving data accuracy and enhancing patient care management.

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