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ICD-10 Guide
ICD-10 CodesM84.67

M84.67

Billable

Pathological fracture in other disease, ankle and foot

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

Code Description

ICD-10 M84.67 is a billable code used to indicate a diagnosis of pathological fracture in other disease, ankle and foot.

Key Diagnostic Point:

Pathological fractures in the ankle and foot occur when the bone breaks due to underlying diseases that compromise bone integrity, such as osteoporosis, osteomalacia, or metastatic cancer. These fractures are not the result of trauma but rather occur spontaneously or with minimal stress due to weakened bone structure. Osteoporosis, characterized by decreased bone density and quality, is a common cause of such fractures, particularly in older adults. The ankle and foot are frequent sites for these fractures due to their weight-bearing function and the stress they endure during daily activities. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the underlying bone condition. Management may include pain control, immobilization, and addressing the underlying disease to prevent future fractures. Understanding the patient's medical history, including any chronic conditions affecting bone metabolism, is crucial for accurate diagnosis and treatment planning.

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 clearly indicate the pathological nature of the fracture.
  • Need for comprehensive patient history to support coding.

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 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 after minimal trauma, particularly in older adults.

Billing Considerations

Ensure imaging results are included in documentation to support the diagnosis.

Endocrinology

Documentation Requirements

Comprehensive assessment of bone density and metabolic disorders.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Document any treatments for underlying conditions that may affect fracture risk.

Coding Guidelines

Inclusion Criteria

Use M84.67 When
  • According to ICD
  • 10 guidelines, M84
  • 67 should be used when a fracture occurs in the context of another disease affecting bone integrity
  • Coders must ensure that the underlying condition is documented and that the fracture is confirmed through imaging

Exclusion Criteria

Do NOT use M84.67 When
  • Exclusion criteria include fractures resulting from trauma or those not associated with a pathological condition

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 swelling from a fracture.

Documentation Requirements

Document the reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists often perform this procedure.

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. M84.67 provides a clear distinction for fractures occurring in the context of other diseases, facilitating better patient management and research into 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. M84.67 provides a clear distinction for fractures occurring in the context of other diseases, facilitating better patient management and research into 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. M84.67 provides a clear distinction for fractures occurring in the context of other diseases, facilitating better patient management and research into 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 due to underlying diseases that weaken the bone, while a traumatic fracture results from an external force or injury.