ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesM84.421

M84.421

Billable

Pathological fracture, right humerus

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

Code Description

ICD-10 M84.421 is a billable code used to indicate a diagnosis of pathological fracture, right humerus.

Key Diagnostic Point:

A pathological fracture of the right humerus occurs when the bone breaks due to an underlying disease process rather than from a traumatic injury. This type of fracture is often associated with conditions such as osteoporosis, metastatic cancer, or other bone density disorders that weaken the structural integrity of the bone. In patients with osteoporosis, the bone density is significantly reduced, making the bones more susceptible to fractures even with minimal or no trauma. The right humerus, being a long bone in the upper arm, is particularly vulnerable in individuals with compromised 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, stabilization of the fracture, and treatment of the underlying condition to improve bone density and prevent future fractures. Understanding the etiology of the fracture is crucial for effective treatment and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between traumatic and pathological fractures
  • Understanding the underlying conditions contributing to the fracture
  • Documentation of bone density testing results
  • Co-morbidities that may affect treatment and coding

Audit Risk Factors

  • Inadequate documentation of the underlying condition causing the fracture
  • Failure to include bone density test results
  • Misclassification of traumatic versus pathological fractures
  • Lack of detailed treatment plans in the medical record

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture type, location, and treatment plan, including imaging results.

Common Clinical Scenarios

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

Billing Considerations

Ensure documentation reflects the underlying bone health status and any treatments for osteoporosis.

Endocrinology

Documentation Requirements

Documentation of bone density tests, metabolic bone disease evaluations, and treatment plans.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Documenting the patient's history of bone density testing and any medications prescribed for bone health.

Coding Guidelines

Inclusion Criteria

Use M84.421 When
  • According to ICD
  • 10 guidelines, M84
  • 421 should be used when a pathological fracture is confirmed, and the underlying condition is documented
  • It is important to ensure that the fracture is not due to trauma and that the patient's bone health status is clearly outlined in the medical record

Exclusion Criteria

Do NOT use M84.421 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 or therapeutic purposes.

Documentation Requirements

Document the reason for the procedure, including 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 ability to capture the complexity of these cases and the underlying conditions that contribute to them. This specificity 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 the underlying conditions that contribute to them. This specificity 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 the underlying conditions that contribute to them. This specificity 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.