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ICD-10 Guide
ICD-10 CodesM84.634

M84.634

Billable

Pathological fracture in other disease, left radius

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

Code Description

ICD-10 M84.634 is a billable code used to indicate a diagnosis of pathological fracture in other disease, left radius.

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 M84.634, this code specifically refers to a pathological fracture of the left radius due to underlying conditions such as osteoporosis, metastatic cancer, or other metabolic bone diseases. Osteoporosis is characterized by decreased bone density and quality, leading to an increased risk of fractures even with minimal or no trauma. The left radius, one of the two bones in the forearm, is particularly susceptible to fractures in individuals with compromised bone health. The diagnosis of a pathological fracture typically involves imaging studies such as X-rays or MRIs, which reveal the fracture and any underlying bone density issues. Management may include pain control, stabilization of the fracture, and treatment of the underlying disease to improve bone health. Understanding the etiology of the fracture is crucial for effective treatment and prevention of future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying diseases affecting bone density.
  • Differentiation from traumatic fractures can be challenging.
  • Documentation must specify the underlying condition causing the fracture.
  • Knowledge of anatomical terminology is necessary for accurate coding.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the location of the fracture accurately.
  • Misclassification of the fracture type (pathological vs. traumatic).
  • Lack of imaging reports to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, notes on fracture management, and underlying conditions.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, often with a history of osteoporosis or malignancy.

Billing Considerations

Ensure that the documentation clearly states the cause of the fracture and any treatments provided.

Endocrinology

Documentation Requirements

Comprehensive evaluation of bone density, lab results indicating metabolic bone disease.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders experiencing fractures.

Billing Considerations

Document the patient's bone density status and any medications affecting bone metabolism.

Coding Guidelines

Inclusion Criteria

Use M84.634 When
  • According to ICD
  • 10 guidelines, M84
  • 634 should be used when a pathological fracture occurs in the context of another disease
  • Coders must ensure that the underlying condition is documented and coded appropriately
  • This code is part of a broader category of pathological fractures, and coders should be familiar with the specific guidelines for each related code

Exclusion Criteria

Do NOT use M84.634 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 when a patient with a pathological fracture requires joint aspiration.

Documentation Requirements

Document the reason for the procedure and the patient's condition.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is linked to 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 ability to capture the complexity of these cases. M84.634 provides a clear distinction for coders to identify 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 ability to capture the complexity of these cases. M84.634 provides a clear distinction for coders to identify fractures due to underlying diseases, which was less defined in ICD-9.

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. M84.634 provides a clear distinction for coders to identify 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 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 essential to differentiate between the two for accurate coding.