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ICD-10 Guide
ICD-10 CodesM84.41

M84.41

Billable

Pathological fracture, shoulder

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

Code Description

ICD-10 M84.41 is a billable code used to indicate a diagnosis of pathological fracture, shoulder.

Key Diagnostic Point:

A pathological fracture of the shoulder occurs when a bone in the shoulder region breaks due to an underlying disease process rather than from a traumatic injury. This type of fracture is often associated with conditions that weaken bone density, such as osteoporosis, metastatic cancer, or other metabolic bone disorders. In patients with osteoporosis, the structural integrity of the bone is compromised, leading to an increased risk of fractures even with minimal or no trauma. The shoulder, comprising the humerus, scapula, and clavicle, is particularly vulnerable in elderly populations or those with chronic conditions affecting bone health. Diagnosis typically involves imaging studies such as X-rays or CT scans to confirm the fracture and assess the extent of bone loss. Management may include pain control, physical therapy, and in some cases, surgical intervention to stabilize the fracture. Understanding the underlying causes of bone density disorders is crucial for effective treatment and prevention of future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between traumatic and pathological fractures
  • Understanding the underlying conditions contributing to bone density loss
  • Documentation of prior medical history related to osteoporosis or other metabolic disorders
  • Accurate coding of associated conditions that may complicate the fracture

Audit Risk Factors

  • Inadequate documentation of the underlying cause of the fracture
  • Failure to specify whether the fracture is traumatic or pathological
  • Lack of imaging reports to support the diagnosis
  • Inconsistent coding of associated osteoporosis or metabolic disorders

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture type, location, and any surgical interventions performed.

Common Clinical Scenarios

Patients presenting with shoulder pain and a history of osteoporosis or cancer.

Billing Considerations

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

Endocrinology

Documentation Requirements

Comprehensive evaluation of bone density tests and metabolic conditions.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Document the patient's history of bone density tests and any treatments for osteoporosis.

Coding Guidelines

Inclusion Criteria

Use M84.41 When
  • According to ICD
  • 10 guidelines, M84
  • 41 should be used when a fracture occurs due to an underlying pathological condition
  • Coders must ensure that the documentation supports the diagnosis of a pathological fracture and includes details about the underlying condition

Exclusion Criteria

Do NOT use M84.41 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 for diagnostic purposes.

Documentation Requirements

Document the indication for the procedure and any imaging 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 accuracy of data collection and reimbursement processes. M84.41 provides a clear distinction from traumatic fractures, which is essential for appropriate management and treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the accuracy of data collection and reimbursement processes. M84.41 provides a clear distinction from traumatic fractures, which is essential for appropriate management and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. M84.41 provides a clear distinction from traumatic fractures, which is essential for appropriate management and treatment planning.

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.