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ICD-10 Guide
ICD-10 CodesM84.434

M84.434

Billable

Pathological fracture, left radius

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

Code Description

ICD-10 M84.434 is a billable code used to indicate a diagnosis of pathological fracture, left radius.

Key Diagnostic Point:

A pathological fracture of the left radius occurs when the bone breaks due to underlying conditions that weaken the bone structure, rather than from an acute trauma. 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 arise from other conditions affecting bone metabolism, including malignancies, metabolic bone diseases, or chronic inflammatory conditions. In the case of the left radius, the fracture may present with localized pain, swelling, and decreased range of motion. Diagnosis typically involves imaging studies such as X-rays or CT scans to confirm the fracture and assess the extent of bone involvement. Management may include pain control, stabilization of the fracture, and treatment of the underlying condition to 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 underlying conditions contributing to bone weakness
  • Documentation of prior medical history related to bone density disorders
  • Accurate identification of the specific site of the fracture

Audit Risk Factors

  • Inadequate documentation of the underlying condition causing the fracture
  • Failure to specify the laterality of the fracture
  • Misclassification of the fracture type (pathological vs. traumatic)
  • Lack of imaging reports to support the diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture location, type, and any imaging studies performed.

Common Clinical Scenarios

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

Billing Considerations

Ensure that the underlying causes of bone density loss are documented, such as osteoporosis or malignancies.

Endocrinology

Documentation Requirements

Documentation of metabolic bone diseases, including lab results indicating bone density.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic disorders presenting with fractures.

Billing Considerations

Documenting the patient's history of bone density tests and treatments for osteoporosis.

Coding Guidelines

Inclusion Criteria

Use M84.434 When
  • According to ICD
  • 10 guidelines, M84
  • 434 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
  • The code should be used in conjunction with codes for the underlying condition when applicable

Exclusion Criteria

Do NOT use M84.434 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 left 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, improving the ability to capture the complexity of these cases and their underlying causes. 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 their underlying causes. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

reimbursement and to avoid claim denials.

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.