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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.633

M84.633

Billable

Pathological fracture in other disease, right radius

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

Code Description

ICD-10 M84.633 is a billable code used to indicate a diagnosis of pathological fracture in other disease, right radius.

Key Diagnostic Point:

A pathological fracture in the right radius occurs when the bone breaks due to an underlying disease process rather than from trauma. This type of fracture is often associated with conditions that affect bone density and metabolism, such as osteoporosis, osteogenesis imperfecta, or metastatic bone disease. In patients with osteoporosis, for instance, the structural integrity of the bone is compromised, leading to increased fragility and susceptibility to fractures even with minimal or no trauma. The right radius, being one of the forearm bones, is particularly vulnerable in individuals with these conditions. Diagnosis typically involves imaging studies such as X-rays or CT scans to confirm the fracture and assess the underlying bone quality. Management may include pain control, stabilization of the fracture, and treatment of the underlying disease to improve bone density and prevent future fractures. Understanding the etiology of the fracture is crucial for effective treatment and prevention strategies, as well as for accurate coding and billing purposes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying diseases affecting bone health.
  • 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 of the fracture type (pathological vs. traumatic).
  • Lack of follow-up documentation on treatment and outcomes.

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, often with a history of osteoporosis.

Billing Considerations

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

Endocrinology

Documentation Requirements

Comprehensive assessment of bone density and metabolic disorders.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases presenting with fractures.

Billing Considerations

Documenting the patient's bone density status and any treatments for osteoporosis is crucial.

Coding Guidelines

Inclusion Criteria

Use M84.633 When
  • According to ICD
  • 10 coding guidelines, M84
  • 633 should be used when a fracture occurs in the context of an underlying disease
  • Coders must ensure that the underlying condition is documented and that the fracture is not due to trauma
  • It is important to follow the guidelines for coding pathological fractures, including the need for specificity in the documentation

Exclusion Criteria

Do NOT use M84.633 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

25600CPT Code

Closed treatment of distal radius fracture

Clinical Scenario

Used when a patient with a pathological fracture requires closed reduction.

Documentation Requirements

Document the type of fracture and any underlying conditions.

Specialty Considerations

Orthopedic specialists should ensure that the fracture type is clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding fractures, particularly pathological fractures. M84.633 provides a clear distinction between fractures due to underlying diseases and those resulting from trauma, improving data accuracy and patient care management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding fractures, particularly pathological fractures. M84.633 provides a clear distinction between fractures due to underlying diseases and those resulting from trauma, improving data accuracy and patient care management.

Reimbursement & Billing Impact

reimbursement and to avoid claim denials.

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. Accurate coding requires understanding this distinction.