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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.611

M84.611

Billable

Pathological fracture in other disease, right shoulder

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

Code Description

ICD-10 M84.611 is a billable code used to indicate a diagnosis of pathological fracture in other disease, right shoulder.

Key Diagnostic Point:

A pathological fracture in the right shoulder occurs when a bone breaks in the shoulder region due to an underlying disease process rather than from an acute injury. This type of fracture is often associated with conditions that weaken bone density, such as osteoporosis, metastatic cancer, or other metabolic bone diseases. In patients with osteoporosis, the structural integrity of the bone is compromised, leading to an increased risk of fractures even with minimal trauma. The right shoulder, comprising the humerus, scapula, and clavicle, can be particularly vulnerable in these cases. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the extent of bone loss. Treatment may include pain management, physical therapy, and in some cases, surgical intervention to stabilize the fracture. Understanding the underlying disease process is crucial for effective management and prevention of future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying diseases affecting bone density.
  • Differentiation from traumatic fractures.
  • Need for precise documentation of the underlying condition.
  • Potential for multiple comorbidities affecting coding.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the location of the fracture.
  • Misclassification as a traumatic fracture.
  • Lack of imaging documentation to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture type, location, and underlying conditions.

Common Clinical Scenarios

Patients presenting with shoulder pain and a history of osteoporosis or malignancy.

Billing Considerations

Ensure imaging results are included in the documentation.

Endocrinology

Documentation Requirements

Comprehensive assessment of bone density and metabolic disorders.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Document any treatments for underlying conditions that may affect bone health.

Coding Guidelines

Inclusion Criteria

Use M84.611 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the underlying disease is documented
  • Include any relevant comorbidities that may affect the patient's bone health
  • Use additional codes to specify the nature of the underlying condition when applicable

Exclusion Criteria

Do NOT use M84.611 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 managing joint pain associated with a pathological fracture.

Documentation Requirements

Document the reason for the procedure and any imaging findings.

Specialty Considerations

Orthopedic specialists may perform this procedure for pain 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, improving the ability to capture the complexity of these cases and the underlying conditions affecting bone health.

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 these cases and the underlying conditions affecting bone health.

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 these cases and the underlying conditions affecting bone health.

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 an underlying disease that weakens the bone, while a traumatic fracture results from an external force or injury.