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ICD-10 Guide
ICD-10 CodesM84.576

M84.576

Billable

Pathological fracture in neoplastic disease, unspecified foot

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

Code Description

ICD-10 M84.576 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, unspecified foot.

Key Diagnostic Point:

Pathological fractures occur when bones weaken due to underlying conditions, such as neoplastic diseases, which include various types of cancers. In the case of M84.576, the fracture is specifically located in the foot and is classified as 'unspecified,' indicating that the exact location within the foot is not detailed. Neoplastic diseases can lead to bone density disorders, such as osteoporosis, where the structural integrity of bones is compromised, making them more susceptible to fractures. These fractures can occur with minimal or no trauma, often presenting as sudden pain and swelling in the affected area. The management of pathological fractures in patients with neoplastic diseases often involves a multidisciplinary approach, including oncologists, orthopedic surgeons, and rehabilitation specialists. Treatment may include surgical intervention, pain management, and addressing the underlying neoplastic condition to improve bone health and prevent further fractures. Understanding the relationship between bone metabolism, cancer, and fracture risk is crucial for effective patient management and coding accuracy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of neoplastic disease types
  • Need for precise localization of the fracture
  • Differentiation from other types of fractures
  • Potential for multiple underlying conditions affecting bone health

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease
  • Failure to specify the exact location of the fracture
  • Lack of evidence for the pathological nature of the fracture
  • Inconsistent coding of related conditions

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of the type and stage of neoplastic disease, treatment history, and any related bone health assessments.

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Ensure that the relationship between the neoplastic disease and the fracture is clearly documented.

Orthopedics

Documentation Requirements

Comprehensive notes on fracture assessment, imaging results, and treatment plans.

Common Clinical Scenarios

Management of fractures in patients with known cancer history.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use M84.576 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant details about the neoplastic disease and its impact on bone health

Exclusion Criteria

Do NOT use M84.576 When
  • Exclude codes that specify fractures due to trauma unless they are clearly documented as pathological

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 effusions related to fractures.

Documentation Requirements

Document the indication for the procedure and any imaging results.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is linked to the fracture diagnosis.

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, improving the ability to capture the complexity of conditions like M84.576. This specificity aids in better understanding patient populations and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the ability to capture the complexity of conditions like M84.576. This specificity aids in better understanding patient populations and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the ability to capture the complexity of conditions like M84.576. This specificity aids in better understanding patient populations and resource allocation.

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 specifying the fracture location?

Specifying the fracture location is crucial for treatment planning and understanding the impact of the fracture on the patient's mobility and overall health. It also aids in accurate coding and billing.