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ICD-10 Guide
ICD-10 CodesM84.652

M84.652

Billable

Pathological fracture in other disease, left femur

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

Code Description

ICD-10 M84.652 is a billable code used to indicate a diagnosis of pathological fracture in other disease, left femur.

Key Diagnostic Point:

A pathological fracture refers to a break in a bone that occurs due to an underlying disease process rather than from a traumatic injury. In the case of M84.652, the fracture is specifically located in the left femur. This type of fracture is often associated with conditions that affect bone density and metabolism, such as osteoporosis, metastatic cancer, or other metabolic bone diseases. Osteoporosis, characterized by decreased bone mass and deterioration of bone tissue, significantly increases the risk of fractures, particularly in weight-bearing bones like the femur. Patients with osteoporosis may experience fractures from minimal trauma, such as a fall from standing height. Other diseases that can lead to pathological fractures include Paget's disease, osteogenesis imperfecta, and certain endocrine disorders. The management of these fractures often involves addressing the underlying condition, pain management, and rehabilitation to restore function. Accurate coding is essential for proper treatment planning and reimbursement, as it reflects the complexity of the patient's condition and the need for specialized care.

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 location of the fracture accurately.
  • Misclassification of the fracture type (pathological vs. traumatic).
  • Lack of supporting clinical evidence for the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, history of osteoporosis or other metabolic bone diseases.

Billing Considerations

Ensure that the underlying disease is well-documented to support the diagnosis.

Endocrinology

Documentation Requirements

Comprehensive evaluation of metabolic bone diseases and their management.

Common Clinical Scenarios

Patients with osteoporosis or other endocrine disorders leading to bone fragility.

Billing Considerations

Documentation should include details on bone density testing and treatment plans.

Coding Guidelines

Inclusion Criteria

Use M84.652 When
  • According to ICD
  • 10 guidelines, M84
  • 652 should be used when a pathological fracture occurs due to an underlying disease
  • Coders must ensure that the underlying condition is documented and that the fracture is specified as pathological

Exclusion Criteria

Do NOT use M84.652 When
  • Exclusion criteria include fractures resulting from trauma or those not related to a disease process

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used in conjunction with M84.652 when joint aspiration is needed due to fracture complications.

Documentation Requirements

Document the reason for aspiration and any findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on clinical findings.

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. M84.652 provides a clear indication of the fracture's nature and underlying causes, facilitating 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. M84.652 provides a clear indication of the fracture's nature and underlying causes, facilitating better patient management and resource allocation.

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 identifying the cause of the fracture.