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ICD-10 Guide
ICD-10 CodesM84.622

M84.622

Billable

Pathological fracture in other disease, left humerus

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

Code Description

ICD-10 M84.622 is a billable code used to indicate a diagnosis of pathological fracture in other disease, left humerus.

Key Diagnostic Point:

A pathological fracture is a break in a bone that occurs in an area weakened by disease rather than from trauma. In the case of M84.622, the fracture is specifically located in the left humerus. This type of fracture is often associated with conditions that affect bone density and metabolism, such as osteoporosis, osteogenesis imperfecta, or metastatic bone disease. Patients with these underlying conditions may experience fractures with minimal or no trauma due to the compromised structural integrity of their bones. The left humerus is the long bone of the upper arm, and fractures here can significantly impact mobility and function. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the extent of any underlying disease. Treatment may include pain management, stabilization of the fracture, and addressing the underlying condition to improve bone health and prevent future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate identification of underlying disease causing the fracture.
  • Differentiation from traumatic fractures which may require different coding.
  • Documentation must specify the location and nature of the fracture.
  • Understanding of bone metabolism disorders and their implications on fracture risk.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the exact location of the fracture.
  • Misclassification of the fracture type (pathological vs. traumatic).
  • Lack of supporting imaging documentation.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, clinical notes on fracture assessment, and treatment plans.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, particularly in older adults or those with known bone density disorders.

Billing Considerations

Orthopedic surgeons must ensure that the underlying disease is well-documented to support the diagnosis of a pathological fracture.

Endocrinology

Documentation Requirements

Comprehensive evaluation of bone density, metabolic assessments, and treatment history for osteoporosis or other metabolic bone diseases.

Common Clinical Scenarios

Patients with osteoporosis presenting with fractures, requiring management of both the fracture and the underlying metabolic condition.

Billing Considerations

Endocrinologists should document the patient's bone health status and any treatments that may affect fracture risk.

Coding Guidelines

Inclusion Criteria

Use M84.622 When
  • According to ICD
  • 10 coding guidelines, M84
  • 622 should be used when a pathological fracture occurs in the left humerus due to an underlying disease
  • Coders must ensure that the underlying condition is documented and that the fracture is not due to trauma

Exclusion Criteria

Do NOT use M84.622 When
  • It is essential to follow the inclusion and exclusion criteria for accurate coding

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 reason for the procedure, the joint involved, and any findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on the patient's condition.

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. M84.622 provides a clear distinction between fractures due to underlying diseases and those resulting from trauma, enhancing data accuracy for treatment and research.

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. M84.622 provides a clear distinction between fractures due to underlying diseases and those resulting from trauma, enhancing data accuracy for treatment and research.

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. M84.622 provides a clear distinction between fractures due to underlying diseases and those resulting from trauma, enhancing data accuracy for treatment and research.

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, while a traumatic fracture results from an external force or injury. Accurate coding requires understanding the underlying cause of the fracture.