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ICD-10 Guide
ICD-10 CodesM84.433

M84.433

Billable

Pathological fracture, right radius

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

Code Description

ICD-10 M84.433 is a billable code used to indicate a diagnosis of pathological fracture, right radius.

Key Diagnostic Point:

A pathological fracture of the right radius occurs when the bone breaks due to underlying conditions that weaken the bone structure, rather than from a traumatic injury. This type of fracture is often associated with bone density disorders such as osteoporosis, where the bone becomes porous and brittle, increasing the risk of fractures even with minimal or no trauma. Pathological fractures can also result from other metabolic bone diseases, malignancies, or chronic conditions that affect bone integrity. In the case of the right radius, the fracture may lead to significant functional impairment, pain, and complications in 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, 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 treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between traumatic and pathological fractures
  • Documenting underlying conditions affecting bone density
  • Understanding the implications of osteoporosis and other metabolic disorders
  • Navigating the specifics of fracture location and type

Audit Risk Factors

  • Inadequate documentation of the underlying bone density disorder
  • Failure to specify the type of fracture (e.g., complete vs. incomplete)
  • Misclassification of the fracture as traumatic rather than pathological
  • Lack of supporting imaging studies in the medical record

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, history of osteoporosis, or other metabolic bone diseases.

Billing Considerations

Ensure that all relevant imaging studies and treatment plans are documented to support the diagnosis.

Endocrinology

Documentation Requirements

Comprehensive assessment of bone density and metabolic conditions, including lab results.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders presenting with fractures.

Billing Considerations

Documenting the management of the underlying condition is essential for accurate coding.

Coding Guidelines

Inclusion Criteria

Use M84.433 When
  • According to ICD
  • 10 coding guidelines, M84
  • 433 should be used when a pathological fracture is confirmed, and the underlying condition affecting bone density is documented
  • It is important to include any relevant history of osteoporosis or other metabolic disorders
  • The code should not be used if the fracture is due to trauma without underlying bone pathology

Exclusion Criteria

Do NOT use M84.433 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

25600CPT Code

Closed treatment of distal radius fracture

Clinical Scenario

Used when a patient with a pathological fracture of the right radius requires closed reduction.

Documentation Requirements

Document the type of fracture, treatment provided, and any imaging studies.

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, enabling better tracking of conditions like osteoporosis and their complications. This specificity aids in research and quality improvement initiatives aimed at reducing fracture rates in at-risk populations.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, enabling better tracking of conditions like osteoporosis and their complications. This specificity aids in research and quality improvement initiatives aimed at reducing fracture rates in at-risk populations.

Reimbursement & Billing Impact

reimbursement and to ensure that the patient's medical history is fully represented.

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 or weakness, while a traumatic fracture results from an external force or injury. Proper documentation is essential to differentiate between the two for accurate coding.