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ICD-10 Guide
ICD-10 CodesM84.621

M84.621

Billable

Pathological fracture in other disease, right humerus

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

Code Description

ICD-10 M84.621 is a billable code used to indicate a diagnosis of pathological fracture in other disease, right humerus.

Key Diagnostic Point:

A pathological fracture of the right humerus occurs when the bone breaks 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, osteogenesis imperfecta, or metastatic bone disease. 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 humerus, being a long bone in the upper limb, is particularly susceptible to such fractures, especially in older adults or those with chronic conditions affecting bone metabolism. Diagnosis typically involves imaging studies such as X-rays or CT scans to confirm the fracture and assess the extent of the underlying disease. Management may include surgical intervention, such as fixation or joint replacement, alongside treatment for the underlying condition to improve bone density and prevent future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between traumatic and pathological fractures
  • Identifying the underlying disease causing the fracture
  • Documentation of bone density testing results
  • Understanding the implications of co-existing conditions

Audit Risk Factors

  • Inadequate documentation of the underlying disease
  • Failure to specify the location of the fracture accurately
  • Lack of imaging reports to support the diagnosis
  • Misclassification of the fracture type

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, surgical notes, and history of bone health.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, particularly in older adults.

Billing Considerations

Ensure that the underlying disease is clearly documented to support the diagnosis of a pathological fracture.

Endocrinology

Documentation Requirements

Bone density test results, treatment plans for osteoporosis or other metabolic bone diseases.

Common Clinical Scenarios

Patients with osteoporosis experiencing fractures or those with metabolic bone disorders.

Billing Considerations

Documentation should include details on the management of the underlying condition to justify the fracture diagnosis.

Coding Guidelines

Inclusion Criteria

Use M84.621 When
  • According to ICD
  • 10 guidelines, M84
  • 621 should be used when a fracture is 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 M84.621 When
  • Exclusion criteria include fractures resulting from trauma or those not associated with a known 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 a patient with a pathological fracture requires joint aspiration.

Documentation Requirements

Document the reason for aspiration and any findings.

Specialty Considerations

Orthopedic specialists should ensure that the aspiration is necessary for treatment.

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.