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ICD-10 Guide
ICD-10 CodesM84.422

M84.422

Billable

Pathological fracture, left humerus

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

Code Description

ICD-10 M84.422 is a billable code used to indicate a diagnosis of pathological fracture, left humerus.

Key Diagnostic Point:

A pathological fracture of the left 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. Osteoporosis, characterized by decreased bone mass and deterioration of bone tissue, significantly increases the risk of fractures, particularly in the elderly population. In patients with osteoporosis, even minor falls or stresses can lead to fractures. The left humerus is the long bone of the upper arm, and fractures in this area can lead to significant functional impairment, affecting mobility and daily activities. Diagnosis typically involves imaging studies such as X-rays or CT scans 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 causes 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 such as osteoporosis
  • Documenting the specific location and type of fracture
  • Understanding the patient's medical history and comorbidities

Audit Risk Factors

  • Inadequate documentation of the underlying condition
  • Failure to specify the type of fracture (e.g., displaced vs. non-displaced)
  • Lack of imaging reports to support the diagnosis
  • Incorrect linkage between the fracture and the underlying disease

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, surgical notes, and follow-up assessments.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, elderly patients with osteoporosis.

Billing Considerations

Ensure that the documentation clearly states the nature of the fracture and any underlying conditions.

Endocrinology

Documentation Requirements

Bone density test results, history of osteoporosis or metabolic bone disease.

Common Clinical Scenarios

Patients with a history of fractures and diagnosed osteoporosis.

Billing Considerations

Documenting the patient's bone health status and treatment history is essential.

Coding Guidelines

Inclusion Criteria

Use M84.422 When
  • According to ICD
  • 10 guidelines, M84
  • 422 should be used when the fracture is confirmed as pathological due to an underlying condition
  • Coders must ensure that the documentation supports the diagnosis and includes details about the patient's medical history and any relevant imaging studies

Exclusion Criteria

Do NOT use M84.422 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20605CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used for joint pain management in patients with fractures.

Documentation Requirements

Document the reason for the procedure and the joint involved.

Specialty Considerations

Orthopedic specialists may frequently perform this procedure in conjunction with fracture management.

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.

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.

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.

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.