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ICD-10 Guide
ICD-10 CodesM84.649

M84.649

Billable

Pathological fracture in other disease, unspecified hand

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

Code Description

ICD-10 M84.649 is a billable code used to indicate a diagnosis of pathological fracture in other disease, unspecified hand.

Key Diagnostic Point:

M84.649 refers to a pathological fracture occurring in the hand due to an underlying disease process, rather than from a traumatic injury. This code is often associated with conditions that affect bone density and metabolism, such as osteoporosis, osteogenesis imperfecta, or metastatic bone disease. Pathological fractures can occur when the structural integrity of the bone is compromised due to these diseases, leading to fractures even with minimal or no trauma. In the case of the hand, these fractures may involve the phalanges, metacarpals, or carpal bones. The diagnosis requires careful evaluation of the patient's medical history, including any known bone density disorders, and may necessitate imaging studies to confirm the presence of a fracture and assess the underlying bone condition. Treatment typically involves addressing the underlying disease, managing pain, and ensuring proper healing of the fracture, which may include immobilization or surgical intervention depending on the severity and location of the fracture.

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 clearly indicate the pathological nature of the fracture.
  • May involve multiple specialties for comprehensive care.

Audit Risk Factors

  • Insufficient documentation of the underlying disease.
  • Inconsistent coding of fracture type (pathological vs. traumatic).
  • Lack of imaging studies to support the diagnosis.
  • Failure to document the specific location of the fracture.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture assessment, treatment plan, and follow-up care.

Common Clinical Scenarios

Patients with osteoporosis presenting with wrist fractures after minimal trauma.

Billing Considerations

Ensure clear documentation of the fracture's pathological nature and any underlying conditions.

Endocrinology

Documentation Requirements

Comprehensive evaluation of bone density and metabolic disorders.

Common Clinical Scenarios

Patients with metabolic bone diseases presenting with fractures.

Billing Considerations

Document any hormonal treatments or interventions affecting bone health.

Coding Guidelines

Inclusion Criteria

Use M84.649 When
  • According to ICD
  • 10 guidelines, M84
  • 649 should be used when a pathological fracture is confirmed in the hand due to an underlying disease
  • It is essential to document the specific disease affecting the bone, as well as the nature of the fracture

Exclusion Criteria

Do NOT use M84.649 When
  • Exclusions include fractures resulting from trauma or those that are not clearly linked to a pathological process

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 any findings.

Specialty Considerations

Orthopedic specialists should ensure clear documentation of the fracture and its implications.

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. M84.649 provides a clear designation for fractures due to underlying diseases, which aids in better tracking and management of patients with bone density disorders.

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. M84.649 provides a clear designation for fractures due to underlying diseases, which aids in better tracking and management of patients with bone density disorders.

Reimbursement & Billing Impact

impact on bone health are essential for justifying the use of this code.

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. Proper documentation is crucial to differentiate between the two.