ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesM84.62

M84.62

Billable

Pathological fracture in other disease, humerus

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

Code Description

ICD-10 M84.62 is a billable code used to indicate a diagnosis of pathological fracture in other disease, humerus.

Key Diagnostic Point:

A pathological fracture of the humerus occurs when the bone breaks due to an underlying disease process rather than from a direct trauma. This type of fracture is often associated with conditions that affect bone density and metabolism, such as osteoporosis, osteogenesis imperfecta, or metastatic cancer. In patients with osteoporosis, the bone becomes porous and brittle, leading to an increased risk of fractures even with minimal or no trauma. The humerus, being a long bone in the upper arm, is particularly susceptible to such fractures in elderly populations or those with chronic diseases affecting bone health. Diagnosis typically involves imaging studies such as X-rays or CT scans to confirm the fracture and assess the underlying bone condition. Treatment may include pain management, stabilization of the fracture, and addressing the underlying disease to improve bone density and prevent future fractures. Understanding the etiology of the fracture is crucial for effective management and coding, as it influences both treatment options and prognosis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between traumatic and pathological fractures
  • Understanding the underlying diseases affecting bone health
  • Documentation of the specific disease causing the fracture
  • Variability in treatment approaches based on the underlying condition

Audit Risk Factors

  • Inadequate documentation of the underlying disease
  • Failure to specify the location of the fracture
  • Misclassification of the fracture type (traumatic vs. pathological)
  • Lack of imaging reports 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 fractures after minimal trauma, particularly in older adults.

Billing Considerations

Ensure comprehensive documentation of bone density tests and any treatments for osteoporosis.

Endocrinology

Documentation Requirements

Records of metabolic bone disease evaluations and treatment plans.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders experiencing fractures.

Billing Considerations

Document the patient's bone density status and any hormonal treatments.

Coding Guidelines

Inclusion Criteria

Use M84.62 When
  • According to ICD
  • 10 coding guidelines, M84
  • 62 should be used when a fracture occurs due to an underlying disease process
  • Coders must ensure that the underlying condition is documented and that the fracture is confirmed through imaging

Exclusion Criteria

Do NOT use M84.62 When
  • Exclusions include fractures resulting from direct trauma

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

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

Clinical Scenario

Used in conjunction with M84.62 when joint aspiration is needed due to fracture complications.

Documentation Requirements

Document the reason for aspiration and the findings.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between the procedure and the 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 accuracy of data collection and reimbursement processes. M84.62 provides a clear distinction for fractures due to underlying diseases, which was less defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the accuracy of data collection and reimbursement processes. M84.62 provides a clear distinction for fractures due to underlying diseases, which was less defined in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. M84.62 provides a clear distinction for fractures due to underlying diseases, which was less defined in ICD-9.

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 traumatic fracture and a pathological fracture?

A traumatic fracture occurs due to an external force or injury, while a pathological fracture occurs due to an underlying disease that weakens the bone structure, such as osteoporosis or cancer.