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ICD-10 Guide
ICD-10 CodesM84.64

M84.64

Billable

Pathological fracture in other disease, hand

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

Code Description

ICD-10 M84.64 is a billable code used to indicate a diagnosis of pathological fracture in other disease, hand.

Key Diagnostic Point:

M84.64 refers to a pathological fracture occurring in the hand due to underlying diseases that affect bone density and metabolism, such as osteoporosis, osteogenesis imperfecta, or metastatic bone disease. These fractures are not the result of acute trauma but rather arise from weakened bone structure due to chronic conditions. Osteoporosis, characterized by reduced bone mass and deterioration of bone tissue, significantly increases the risk of fractures, particularly in the elderly population. In patients with metabolic bone disorders, the integrity of the bone is compromised, leading to an increased susceptibility to fractures even with minimal or no trauma. The hand is a common site for such fractures, which can lead to significant functional impairment and pain. Accurate diagnosis and documentation are crucial, as these fractures often require specific management strategies, including pain control, rehabilitation, and sometimes surgical intervention. Understanding the underlying disease process is essential for effective treatment and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying diseases affecting bone density.
  • Differentiation from traumatic fractures.
  • Documentation must specify the underlying condition.
  • Potential for multiple co-existing conditions.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the exact location of the fracture.
  • Misclassification as a traumatic fracture.
  • Lack of supporting clinical evidence for the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes on fracture type, location, and underlying conditions.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, often in the elderly.

Billing Considerations

Ensure that the underlying disease is well-documented to support the use of M84.64.

Endocrinology

Documentation Requirements

Comprehensive evaluation of bone density and metabolic disorders.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Documentation should include bone density test results and treatment history.

Coding Guidelines

Inclusion Criteria

Use M84.64 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include details about the underlying disease and the specific location of the fracture

Exclusion Criteria

Do NOT use M84.64 When
  • Exclude codes for traumatic fractures unless there is clear documentation of both conditions

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 underlying condition.

Specialty Considerations

Orthopedic specialists should ensure that the fracture is documented as pathological.

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 their underlying causes, which aids in better patient management 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 capture the complexity of these cases and their underlying causes, which aids in better patient management and resource allocation.

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 their underlying causes, which aids in better patient management and resource allocation.

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 M84.64 and S52.5?

M84.64 is used for pathological fractures due to underlying diseases, while S52.5 is for traumatic fractures of the hand. Accurate documentation is essential to determine the correct code.