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ICD-10 Guide
ICD-10 CodesM84.66

M84.66

Billable

Pathological fracture in other disease, tibia and fibula

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

Code Description

ICD-10 M84.66 is a billable code used to indicate a diagnosis of pathological fracture in other disease, tibia and fibula.

Key Diagnostic Point:

Pathological fractures of the tibia and fibula occur when these bones break due to underlying diseases rather than from trauma. Conditions such as osteoporosis, osteogenesis imperfecta, Paget's disease, and metastatic cancer can lead to weakened bone density and increased susceptibility to fractures. In osteoporosis, for instance, the bone density decreases, making bones fragile and more likely to fracture even with minimal stress. The tibia and fibula, being weight-bearing bones, are particularly vulnerable. These fractures can present with pain, swelling, and deformity, and may require imaging studies for diagnosis. Treatment often involves addressing the underlying condition, pain management, and in some cases, surgical intervention to stabilize the fracture. Understanding the etiology of the fracture is crucial for effective management and coding, as it impacts the patient's overall health and treatment plan.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying diseases affecting bone health.
  • Differentiation from traumatic fractures.
  • Documentation must specify the underlying condition.
  • Potential for multiple comorbidities affecting coding.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the location of the fracture.
  • Incorrect coding of fracture type (e.g., traumatic vs. pathological).
  • Lack of supporting imaging or clinical notes.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients with osteoporosis presenting with fractures after minimal trauma.

Billing Considerations

Ensure that the underlying disease is clearly documented to support the diagnosis.

Endocrinology

Documentation Requirements

Comprehensive assessment of bone density and metabolic disorders.

Common Clinical Scenarios

Patients with metabolic bone diseases leading to fractures.

Billing Considerations

Documentation should include bone density test results and treatment plans.

Coding Guidelines

Inclusion Criteria

Use M84.66 When
  • According to ICD
  • 10 guidelines, M84
  • 66 should be used when a fracture occurs due to an underlying disease process
  • Coders must ensure that the underlying condition is documented and that the fracture is not due to trauma

Exclusion Criteria

Do NOT use M84.66 When
  • It is important to follow the inclusion and exclusion criteria outlined in the coding manual

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 fracture complications.

Documentation Requirements

Document the reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between the procedure and the diagnosis.

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. M84.66 provides a clear distinction for coders to identify fractures due to underlying diseases, 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. M84.66 provides a clear distinction for coders to identify fractures due to underlying diseases, which aids in better patient management and resource allocation.

Reimbursement & Billing Impact

reimbursement.

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 underlying diseases that weaken the bone, while a traumatic fracture results from an external force or injury.