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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.653

M84.653

Billable

Pathological fracture in other disease, unspecified femur

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

Code Description

ICD-10 M84.653 is a billable code used to indicate a diagnosis of pathological fracture in other disease, unspecified femur.

Key Diagnostic Point:

A pathological fracture is a break in a bone that occurs in a bone weakened by disease rather than by trauma. The M84.653 code specifically refers to a pathological fracture of the femur that is not attributed to a specific underlying disease. Common causes of such fractures include osteoporosis, metastatic cancer, and other bone density disorders that compromise bone integrity. Osteoporosis, characterized by reduced bone mass and deterioration of bone tissue, significantly increases the risk of fractures, particularly in the elderly population. In cases where the femur is affected, patients may experience severe pain, inability to bear weight, and deformity. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the underlying bone condition. Treatment may include surgical intervention, such as fixation or replacement, alongside management of the underlying disease to improve bone density and prevent future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying conditions that can lead to pathological fractures.
  • Need for precise documentation of the underlying disease.
  • Differentiation from traumatic fractures.
  • Potential for multiple comorbidities affecting bone health.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the location of the fracture.
  • Misclassification of the fracture type (pathological vs. traumatic).
  • Lack of follow-up documentation regarding treatment and outcomes.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, surgical notes, and follow-up assessments.

Common Clinical Scenarios

Patients presenting with hip pain and a history of osteoporosis or malignancy.

Billing Considerations

Ensure clear documentation of the fracture type and any underlying conditions.

Endocrinology

Documentation Requirements

Bone density test results, treatment plans for osteoporosis, and patient history.

Common Clinical Scenarios

Patients with osteoporosis experiencing fractures despite treatment.

Billing Considerations

Documenting the effectiveness of osteoporosis management in preventing fractures.

Coding Guidelines

Inclusion Criteria

Use M84.653 When
  • According to ICD
  • 10 guidelines, M84
  • 653 should be used when a pathological fracture is confirmed, and the underlying disease is unspecified
  • Coders must ensure that documentation supports the diagnosis and that the fracture is not due to trauma

Exclusion Criteria

Do NOT use M84.653 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27447CPT Code

Total hip arthroplasty

Clinical Scenario

Used for surgical repair of a femoral fracture.

Documentation Requirements

Operative reports and pre-operative assessments.

Specialty Considerations

Orthopedic surgeons must document the indication for surgery and any comorbidities.

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. M84.653 provides a clear designation for fractures that occur due to diseases affecting bone density.

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. M84.653 provides a clear designation for fractures that occur due to diseases affecting bone density.

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. M84.653 provides a clear designation for fractures that occur due to diseases affecting bone density.

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.