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ICD-10 Guide
ICD-10 CodesM84.662

M84.662

Billable

Pathological fracture in other disease, left tibia

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

Code Description

ICD-10 M84.662 is a billable code used to indicate a diagnosis of pathological fracture in other disease, left tibia.

Key Diagnostic Point:

A pathological fracture refers to a break in a bone that occurs due to a disease process rather than from an external force or trauma. In the case of M84.662, the fracture is specifically located in the left tibia. This type of fracture is often associated with conditions that weaken bone integrity, such as osteoporosis, osteogenesis imperfecta, or metastatic bone disease. Osteoporosis, a common bone density disorder, leads to decreased bone mass and deterioration of bone tissue, making bones more susceptible to fractures even with minimal or no trauma. The left tibia, being a weight-bearing bone, is particularly vulnerable in individuals with compromised bone health. Diagnosis typically involves imaging studies such as X-rays or CT scans 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 improve bone density and prevent future fractures. Understanding the etiology of the fracture 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.
  • Need for accurate documentation of 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 accurately.
  • Misclassification as a traumatic fracture.
  • Lack of supporting imaging documentation.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, clinical notes on bone health, and treatment plans.

Common Clinical Scenarios

Patients presenting with fractures due to osteoporosis or metastatic disease.

Billing Considerations

Ensure that the underlying condition is well-documented to support the diagnosis of a pathological fracture.

Endocrinology

Documentation Requirements

Comprehensive assessment of metabolic bone diseases, including lab results and treatment history.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders experiencing fractures.

Billing Considerations

Documentation should include details on bone density tests and management of the underlying condition.

Coding Guidelines

Inclusion Criteria

Use M84.662 When
  • According to ICD
  • 10 coding guidelines, M84
  • 662 should be used when a fracture occurs in the context of an underlying disease affecting bone integrity
  • Coders must ensure that the underlying condition is documented and that the fracture is not due to trauma

Exclusion Criteria

Do NOT use M84.662 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 in conjunction with M84.662 when joint aspiration is needed due to fracture-related complications.

Documentation Requirements

Document the reason for aspiration and any findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on the patient's condition.

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 the underlying conditions that contribute to them.

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 the underlying conditions that contribute to them.

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 the underlying conditions that contribute to them.

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.