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ICD-10 Guide
ICD-10 CodesM84.574

M84.574

Billable

Pathological fracture in neoplastic disease, right foot

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

Code Description

ICD-10 M84.574 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, right foot.

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, either benign or malignant. In this case, the fracture is located in the right foot. Neoplastic diseases can lead to bone density disorders, such as osteoporosis, by disrupting normal bone metabolism and remodeling processes. Tumors can invade bone tissue, causing structural weakness and increasing the risk of fractures even with minimal or no trauma. Patients with neoplastic diseases often experience pain, swelling, and functional impairment in the affected area. Diagnosis typically involves imaging studies, such as X-rays or MRI, to assess the extent of the fracture and the underlying neoplastic process. Treatment may include stabilization of the fracture, management of the neoplasm, and rehabilitation to restore function. Understanding the relationship between neoplastic disease and bone health is crucial for effective management and coding of these conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their impact on bone health.
  • Differentiation between primary and secondary neoplasms affecting the bone.
  • Need for accurate documentation of the fracture's location and cause.
  • Potential for multiple codes to be applicable based on the patient's overall condition.

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease.
  • Failure to specify the type of fracture (e.g., complete vs. incomplete).
  • Lack of imaging studies to support the diagnosis.
  • Misclassification of the fracture type or location.

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 bone pain and fractures.

Billing Considerations

Need for clear documentation of the relationship between the neoplasm and the fracture.

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Management of fractures in patients with known malignancies.

Billing Considerations

Coordination with oncology for treatment planning and documentation.

Coding Guidelines

Inclusion Criteria

Use M84.574 When
  • According to ICD
  • 10 guidelines, M84
  • 574 should be used when a pathological fracture is confirmed in a patient with a documented neoplastic disease
  • Coders must ensure that the neoplasm is clearly documented and that the fracture's location is specified

Exclusion Criteria

Do NOT use M84.574 When
  • Exclusions include fractures 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 when managing joint effusion in a patient with a pathological fracture.

Documentation Requirements

Document the reason for the procedure and the patient's history of neoplastic disease.

Specialty Considerations

Orthopedic specialists may perform this procedure in conjunction with fracture management.

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.

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 significance of coding M84.574 accurately?

Accurate coding of M84.574 is crucial for proper reimbursement, tracking treatment outcomes, and ensuring that the patient's medical history reflects the complexities of their condition, particularly in the context of neoplastic diseases.