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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.651

M84.651

Billable

Pathological fracture in other disease, right femur

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

Code Description

ICD-10 M84.651 is a billable code used to indicate a diagnosis of pathological fracture in other disease, right femur.

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 right femur, being the longest and strongest bone in the body, can be affected by various conditions that compromise its structural integrity, such as osteoporosis, metastatic cancer, or other metabolic bone diseases. In patients with osteoporosis, for instance, the bone density decreases, leading to increased fragility and susceptibility to fractures even with minimal or no trauma. Pathological fractures can occur in the context of other diseases, such as Paget's disease or osteogenesis imperfecta, where the normal bone remodeling process is disrupted. The clinical presentation may include localized pain, swelling, and decreased mobility. Diagnosis typically involves imaging studies such as X-rays or MRI to confirm the fracture and assess the underlying bone condition. Management may include pain control, stabilization of the fracture, and treatment of the underlying disease to prevent further fractures. Understanding the underlying pathology is crucial for effective treatment and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying diseases affecting bone health.
  • Differentiation from traumatic fractures can be challenging.
  • Documentation must specify the underlying condition causing the fracture.
  • Potential for multiple comorbidities complicating the clinical picture.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the laterality of the fracture.
  • Misclassification as a traumatic fracture.
  • Lack of imaging studies to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with fractures due to osteoporosis or metastatic disease.

Billing Considerations

Ensure that the underlying disease is clearly documented to support the use of M84.651.

Endocrinology

Documentation Requirements

Comprehensive assessment of bone density and metabolic conditions.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders leading to fractures.

Billing Considerations

Documenting the patient's bone density status and treatment history is crucial.

Coding Guidelines

Inclusion Criteria

Use M84.651 When
  • According to ICD
  • 10 guidelines, M84
  • 651 should be used when a pathological fracture occurs in the context of another disease
  • Coders must ensure that the underlying condition is documented and that the fracture is confirmed through imaging
  • The code is specific to the right femur, and coders must ensure accurate laterality is noted

Exclusion Criteria

Do NOT use M84.651 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 joint aspiration is needed due to complications from the fracture.

Documentation Requirements

Document the reason for aspiration and any findings.

Specialty Considerations

Orthopedic specialists may perform this procedure to relieve pressure or pain.

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. M84.651 provides a clear distinction between fractures due to underlying diseases and those resulting from trauma, enhancing data accuracy for epidemiological studies and treatment outcomes.

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. M84.651 provides a clear distinction between fractures due to underlying diseases and those resulting from trauma, enhancing data accuracy for epidemiological studies and treatment outcomes.

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. M84.651 provides a clear distinction between fractures due to underlying diseases and those resulting from trauma, enhancing data accuracy for epidemiological studies and treatment outcomes.

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.