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ICD-10 Guide
ICD-10 CodesM84.7

M84.7

Billable

Nontraumatic fracture, not elsewhere classified

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

Code Description

ICD-10 M84.7 is a billable code used to indicate a diagnosis of nontraumatic fracture, not elsewhere classified.

Key Diagnostic Point:

M84.7 refers to nontraumatic fractures that occur without a direct external force, often associated with underlying conditions such as osteoporosis or other bone density disorders. These fractures can arise from minimal stress or normal activities, particularly in individuals with compromised bone health. Osteoporosis, characterized by reduced bone mass and deterioration of bone tissue, significantly increases the risk of such fractures. The pathophysiology involves an imbalance in bone remodeling, where bone resorption outpaces bone formation, leading to weakened skeletal integrity. Nontraumatic fractures can occur in various locations, including the vertebrae, hip, and wrist, and may present with symptoms such as pain, swelling, and decreased mobility. Accurate diagnosis often requires imaging studies, such as X-rays or MRIs, to confirm the fracture and assess the extent of bone loss. Management typically involves addressing the underlying bone density disorder, pain management, and rehabilitation to restore function and prevent future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying conditions leading to nontraumatic fractures
  • Need for comprehensive documentation of bone density disorders
  • Differentiation from traumatic fractures in clinical notes
  • Potential for multiple sites of fracture complicating coding

Audit Risk Factors

  • Inadequate documentation of the underlying bone density disorder
  • Failure to specify the fracture location
  • Misclassification of traumatic versus nontraumatic fractures
  • Lack of imaging results in the medical record

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture location, type, and any underlying conditions such as osteoporosis.

Common Clinical Scenarios

Patients presenting with hip or vertebral fractures due to osteoporosis.

Billing Considerations

Ensure that all imaging studies and treatment plans are documented to support the diagnosis.

Endocrinology

Documentation Requirements

Comprehensive assessment of bone density and metabolic factors contributing to fractures.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Document any hormonal treatments or interventions that may affect bone density.

Coding Guidelines

Inclusion Criteria

Use M84.7 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture site and any underlying conditions
  • 7 should be used when no specific fracture code applies, and the cause is nontraumatic

Exclusion Criteria

Do NOT use M84.7 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

Radiologic examination, spine, 2 or 3 views

Clinical Scenario

Used to evaluate suspected vertebral fractures in patients with osteoporosis.

Documentation Requirements

Radiology report must be included in the medical record.

Specialty Considerations

Orthopedic specialists should ensure that imaging correlates with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of nontraumatic fractures, improving the ability to track and manage conditions like osteoporosis. M84.7 provides a broader classification for fractures that do not fit neatly into other categories.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of nontraumatic fractures, improving the ability to track and manage conditions like osteoporosis. M84.7 provides a broader classification for fractures that do not fit neatly into other categories.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of nontraumatic fractures, improving the ability to track and manage conditions like osteoporosis. M84.7 provides a broader classification for fractures that do not fit neatly into other categories.

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 M84.7 and M80 codes?

M84.7 is used for nontraumatic fractures not classified elsewhere, while M80 codes specifically relate to osteoporosis with current pathological fractures, providing a clearer link to the underlying condition.