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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.412

M84.412

Billable

Pathological fracture, left shoulder

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

Code Description

ICD-10 M84.412 is a billable code used to indicate a diagnosis of pathological fracture, left shoulder.

Key Diagnostic Point:

A pathological fracture of the left shoulder occurs when a bone breaks in the shoulder region due to an underlying disease process rather than from a traumatic injury. This type of fracture is often associated with conditions that weaken bone integrity, such as osteoporosis, metastatic cancer, or other bone density disorders. Osteoporosis, characterized by reduced bone mass and deterioration of bone tissue, significantly increases the risk of fractures even with minimal or no trauma. In the case of the left shoulder, the humerus or scapula may be involved. Patients may present with pain, swelling, and limited range of motion in the shoulder. Diagnosis typically involves imaging studies such as X-rays or MRI to confirm the fracture and assess the extent of bone loss. Treatment may include pain management, physical therapy, and in some cases, surgical intervention to stabilize the fracture. Understanding the underlying cause of the fracture is crucial for effective management and prevention of future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between traumatic and pathological fractures
  • Identifying underlying conditions contributing to bone weakness
  • Documentation of specific fracture location and type
  • Need for comprehensive patient history regarding bone health

Audit Risk Factors

  • Inadequate documentation of the underlying cause of the fracture
  • Failure to specify the exact location of the fracture
  • Misclassification of a traumatic fracture as pathological
  • Lack of supporting imaging reports

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, surgical notes, and patient history regarding bone health.

Common Clinical Scenarios

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

Billing Considerations

Ensure accurate documentation of fracture type and any surgical interventions performed.

Endocrinology

Documentation Requirements

Thorough evaluation of bone density tests and management of osteoporosis.

Common Clinical Scenarios

Patients with osteoporosis experiencing fractures.

Billing Considerations

Documenting the patient's bone health management plan and any medications prescribed.

Coding Guidelines

Inclusion Criteria

Use M84.412 When
  • According to ICD
  • 10 guidelines, M84
  • 412 should be used when a pathological fracture is confirmed, and the underlying cause is documented
  • It is essential to include any relevant history of bone density disorders or other contributing factors

Exclusion Criteria

Do NOT use M84.412 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 reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists should ensure clear documentation of joint status.

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 and their underlying causes, 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 and their underlying causes, 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 and their underlying causes, 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 underlying disease processes that weaken the bone, while a traumatic fracture results from an external force or injury.