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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.676

M84.676

Billable

Pathological fracture in other disease, unspecified foot

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

Code Description

ICD-10 M84.676 is a billable code used to indicate a diagnosis of pathological fracture in other disease, unspecified foot.

Key Diagnostic Point:

A pathological fracture in the foot occurs when a bone breaks due to an underlying disease rather than from an acute injury. This can be associated with conditions such as osteoporosis, osteogenesis imperfecta, Paget's disease, or metastatic bone disease. In osteoporosis, for instance, the bone density decreases, leading to weakened bones that are more susceptible to fractures even with minimal trauma. The foot, being a complex structure with multiple bones, can be particularly vulnerable to these types of fractures. The unspecified nature of this code indicates that the exact location of the fracture within the foot is not specified, which can complicate treatment and management. Clinicians must assess the patient's history, including any underlying metabolic bone disorders, to determine the cause of the fracture and to implement appropriate interventions aimed at improving bone density and preventing future fractures. Management may include pharmacological treatments, lifestyle modifications, and physical therapy to enhance bone strength and overall mobility.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified location of the fracture can lead to ambiguity in coding.
  • Requires knowledge of underlying diseases that may cause pathological fractures.
  • Differentiating between traumatic and pathological fractures can be challenging.
  • Documentation must clearly indicate the underlying condition contributing to the fracture.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the exact location of the fracture.
  • Misclassification of traumatic versus pathological fractures.
  • Lack of supporting clinical evidence for the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports and clinical notes that specify the fracture type and underlying conditions.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, particularly in older adults.

Billing Considerations

Ensure that the underlying disease is documented to support the use of M84.676.

Endocrinology

Documentation Requirements

Comprehensive evaluation of bone density and metabolic disorders.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Documenting the patient's bone density status and treatment history is crucial.

Coding Guidelines

Inclusion Criteria

Use M84.676 When
  • According to ICD
  • 10 guidelines, M84
  • 676 should be used when a pathological fracture is confirmed, and the underlying disease is documented
  • It is essential to ensure that the fracture is not due to a traumatic event, as this would require a different code

Exclusion Criteria

Do NOT use M84.676 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 when a patient with a pathological fracture requires joint aspiration.

Documentation Requirements

Document the reason for the procedure and the patient's condition.

Specialty Considerations

Orthopedic specialists should ensure that the underlying condition is well-documented.

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. M84.676 provides a clear designation for 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. M84.676 provides a clear designation for fractures due to underlying diseases, which aids in better patient management and resource allocation.

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. M84.676 provides a clear designation for fractures due to underlying diseases, which aids in better patient management and resource allocation.

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.