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ICD-10 Guide
ICD-10 CodesM84.629

M84.629

Billable

Pathological fracture in other disease, unspecified humerus

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

Code Description

ICD-10 M84.629 is a billable code used to indicate a diagnosis of pathological fracture in other disease, unspecified 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. The unspecified humerus indicates that the fracture is located in the upper arm bone but does not specify which part of the humerus is affected. This type of fracture is often associated with conditions that affect bone density and metabolism, such as osteoporosis, osteomalacia, or metastatic bone disease. Patients with these conditions may experience fractures with minimal or no trauma due to the compromised structural integrity of their bones. Osteoporosis, characterized by decreased bone mass and deterioration of bone tissue, is particularly common in older adults and postmenopausal women, leading to an increased risk of fractures. The management of pathological fractures often involves addressing the underlying disease, pain management, and rehabilitation to restore function. Accurate coding is essential for proper treatment planning and reimbursement, as well as for tracking the incidence of fractures related to bone density disorders.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of underlying diseases
  • Need for precise localization of the fracture
  • Differentiation from traumatic fractures
  • Potential for multiple comorbid conditions affecting bone health

Audit Risk Factors

  • Inadequate documentation of the underlying disease
  • Failure to specify the location of the fracture
  • Inconsistent coding of fractures in patients with multiple comorbidities
  • Lack of clarity on whether the fracture was pathological or traumatic

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, surgical notes, and follow-up assessments are necessary to confirm the diagnosis and treatment of the fracture.

Common Clinical Scenarios

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

Billing Considerations

Orthopedic surgeons must document the specific nature of the fracture and any underlying conditions that may have contributed to the fracture.

Endocrinology

Documentation Requirements

Documentation of bone density tests, metabolic assessments, and treatment plans for underlying conditions such as osteoporosis.

Common Clinical Scenarios

Patients with osteoporosis presenting with fractures, requiring evaluation of bone health and metabolic status.

Billing Considerations

Endocrinologists should ensure that the relationship between metabolic disorders and fractures is clearly documented.

Coding Guidelines

Inclusion Criteria

Use M84.629 When
  • According to ICD
  • 10 coding guidelines, M84
  • 629 should be used when a pathological fracture occurs in the humerus due to an unspecified underlying disease
  • Coders must ensure that the documentation supports the diagnosis and that the fracture is not due to trauma
  • It is important to review the patient's medical history for any relevant conditions that may have contributed to the fracture

Exclusion Criteria

Do NOT use M84.629 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 in conjunction with M84.629 when joint aspiration is performed due to associated swelling.

Documentation Requirements

Document the reason for aspiration and any findings during the procedure.

Specialty Considerations

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

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 track and manage conditions related to bone health. M84.629 provides a clear classification for fractures due to unspecified diseases, facilitating better patient care 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 track and manage conditions related to bone health. M84.629 provides a clear classification for fractures due to unspecified diseases, facilitating better patient care and resource allocation.

Reimbursement & Billing Impact

reimbursement.

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. Proper documentation is crucial to differentiate between the two for accurate coding.