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ICD-10 Guide
ICD-10 CodesM84.575

M84.575

Billable

Pathological fracture in neoplastic disease, left foot

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

Code Description

ICD-10 M84.575 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, left 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 the case of M84.575, the fracture specifically affects the left foot. Neoplastic diseases can lead to alterations in bone metabolism, resulting in decreased bone density and structural integrity. This can occur due to direct invasion of the bone by a tumor or as a result of systemic effects of cancer, such as osteolysis or osteopenia. Patients with neoplastic diseases often present with fractures following minimal trauma or even spontaneously. The left foot may be affected by various types of tumors, including metastatic cancers from other sites, primary bone tumors, or hematological malignancies. 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. Management may include surgical intervention, radiation therapy, or pharmacological treatment aimed at addressing both the fracture and the underlying neoplastic condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their effects on bone health.
  • Differentiation from other types of fractures, including traumatic fractures.
  • Need for precise documentation of the neoplastic condition and its relation to the fracture.
  • Potential for multiple coding scenarios based on the underlying malignancy.

Audit Risk Factors

  • Inadequate documentation linking the fracture to the neoplastic disease.
  • Failure to specify the type of neoplasm involved.
  • Misclassification of the fracture type (pathological vs. traumatic).
  • Lack of imaging studies to support the diagnosis.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of the cancer diagnosis, treatment history, and any related complications.

Common Clinical Scenarios

Patients with metastatic bone disease presenting with fractures.

Billing Considerations

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

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

Document the mechanism of injury and any pre-existing conditions affecting bone health.

Coding Guidelines

Inclusion Criteria

Use M84.575 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the neoplastic disease is documented and coded appropriately
  • Include any relevant details about the fracture type and location
  • Ensure compliance with guidelines for coding pathological fractures

Exclusion Criteria

Do NOT use M84.575 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

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

Clinical Scenario

Used when a patient with a pathological fracture requires joint aspiration for diagnostic or therapeutic purposes.

Documentation Requirements

Document the indication for the procedure and any imaging studies performed.

Specialty Considerations

Orthopedic specialists should ensure that the relationship between the fracture and the procedure is clearly documented.

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.

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.

Reimbursement & Billing Impact

reimbursement processes.

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.