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ICD-10 Guide
ICD-10 CodesM84.43

M84.43

Billable

Pathological fracture, ulna and radius

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

Code Description

ICD-10 M84.43 is a billable code used to indicate a diagnosis of pathological fracture, ulna and radius.

Key Diagnostic Point:

A pathological fracture of the ulna and radius occurs when these bones break due to underlying conditions that weaken bone integrity, rather than from a traumatic injury. Common causes include osteoporosis, osteogenesis imperfecta, and metastatic bone disease. Osteoporosis, a condition characterized by decreased bone density and quality, 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 ulna and radius are the two long bones of the forearm, and fractures in these areas can lead to significant functional impairment, pain, and complications such as malunion or nonunion. 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, immobilization, and in some cases, surgical intervention. Understanding the underlying bone metabolism disorders is crucial for effective treatment and prevention of future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying bone density disorders.
  • Differentiation from traumatic fractures.
  • Documentation of osteoporosis or other metabolic bone diseases.
  • Potential for multiple fractures in different locations.

Audit Risk Factors

  • Inadequate documentation of the underlying condition.
  • Failure to specify the type of fracture (e.g., open vs. closed).
  • Misclassification of the fracture as traumatic.
  • Lack of imaging reports to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Ensure that all relevant imaging and lab results are included in the documentation.

Endocrinology

Documentation Requirements

Documentation of bone density tests and metabolic evaluations.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Linking the fracture to the underlying metabolic condition is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M84.43 When
  • According to ICD
  • 10 guidelines, M84
  • 43 should be used when a fracture occurs due to a pathological condition
  • Coders must ensure that the underlying cause, such as osteoporosis, is documented to support the use of this code

Exclusion Criteria

Do NOT use M84.43 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

25600CPT Code

Closed treatment of distal radius fracture

Clinical Scenario

Used when treating a pathological fracture of the radius.

Documentation Requirements

Document the type of fracture and treatment provided.

Specialty Considerations

Orthopedic specialists should ensure accurate coding based on fracture type.

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 underlying bone disease, such as osteoporosis, while a traumatic fracture results from an external force or injury.