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ICD-10 Guide
ICD-10 CodesM84.675

M84.675

Billable

Pathological fracture in other disease, left foot

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

Code Description

ICD-10 M84.675 is a billable code used to indicate a diagnosis of pathological fracture in other disease, left foot.

Key Diagnostic Point:

A pathological fracture in the left foot occurs when a bone breaks due to an underlying disease rather than from an external force or trauma. This type of fracture is often associated with conditions that affect bone density and metabolism, such as osteoporosis, osteogenesis imperfecta, or metastatic bone disease. In patients with osteoporosis, for instance, the bones become porous and brittle, leading to an increased risk of fractures even with minimal or no trauma. The left foot can be particularly vulnerable due to its complex structure and the weight-bearing nature of its bones. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the underlying condition. Treatment may include pain management, immobilization of the fracture, and addressing the underlying disease to improve bone health and prevent future fractures. Understanding the etiology of the fracture is crucial for effective management and coding, as it informs the treatment plan and potential need for further interventions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying diseases affecting bone health.
  • Differentiation from traumatic fractures is necessary.
  • Documentation must specify the underlying condition causing the fracture.
  • Potential for multiple co-morbidities complicating the clinical picture.

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 studies in the medical record.

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, often with a history of osteoporosis.

Billing Considerations

Ensure that the underlying disease is documented to support the use of M84.675.

Endocrinology

Documentation Requirements

Documentation of metabolic bone disease, including lab results and treatment plans.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders experiencing fractures.

Billing Considerations

Coordination with orthopedic notes to ensure comprehensive documentation.

Coding Guidelines

Inclusion Criteria

Use M84.675 When
  • According to ICD
  • 10 guidelines, M84
  • 675 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 M84.675 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 a patient with a pathological fracture requires joint aspiration.

Documentation Requirements

Document the reason for the procedure and the underlying condition.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is linked to 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, enabling better tracking of conditions affecting bone health. M84.675 provides a clear distinction between traumatic and pathological fractures, improving data accuracy for treatment and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, enabling better tracking of conditions affecting bone health. M84.675 provides a clear distinction between traumatic and pathological fractures, improving data accuracy for treatment and research.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pathological fractures, enabling better tracking of conditions affecting bone health. M84.675 provides a clear distinction between traumatic and pathological fractures, improving data accuracy for treatment and research.

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.