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ICD-10 Guide
ICD-10 CodesM84.431

M84.431

Billable

Pathological fracture, right ulna

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

Code Description

ICD-10 M84.431 is a billable code used to indicate a diagnosis of pathological fracture, right ulna.

Key Diagnostic Point:

A pathological fracture of the right ulna 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, osteogenesis imperfecta, or metastatic bone disease, where the structural integrity of the bone is compromised. In patients with osteoporosis, for instance, decreased bone density leads to increased fragility, making bones more susceptible to fractures even with minimal or no trauma. The right ulna, being one of the two long bones in the forearm, can be affected by various factors including age, hormonal changes, and nutritional deficiencies. 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, stabilization of the fracture, and addressing the underlying bone density disorder to prevent future fractures. Proper documentation of the patient's history, including any pre-existing conditions, is crucial for accurate coding and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying bone density disorders.
  • Differentiation from traumatic fractures.
  • Need for comprehensive patient history.
  • Potential for multiple co-morbid conditions.

Audit Risk Factors

  • Inadequate documentation of the underlying condition.
  • Failure to specify the type of fracture.
  • Misclassification as a traumatic fracture.
  • Lack of imaging reports to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture type, location, and treatment plan.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, often with a history of osteoporosis.

Billing Considerations

Ensure that the underlying condition is documented to support the diagnosis of a pathological fracture.

Endocrinology

Documentation Requirements

Documentation of bone density tests and management of osteoporosis.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Linking the fracture to the underlying metabolic disorder is essential for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M84.431 When
  • According to ICD
  • 10 guidelines, M84
  • 431 should be used when a fracture is confirmed to be pathological
  • Coders must ensure that the underlying condition is documented and that the fracture is not due to trauma
  • energy trauma

Exclusion Criteria

Do NOT use M84.431 When
  • Exclusion criteria include fractures resulting from high

Related ICD-10 Codes

Related CPT Codes

25600CPT Code

Closed treatment of fracture, ulna

Clinical Scenario

Used when a closed reduction is performed on a pathological fracture of the ulna.

Documentation Requirements

Document the type of fracture and treatment provided.

Specialty Considerations

Orthopedic specialists should ensure that the fracture type is clearly documented.

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 ensuring better reimbursement for providers managing these conditions.

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 ensuring better reimbursement for providers managing these conditions.

Reimbursement & Billing Impact

reimbursement for providers managing these conditions.

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.