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ICD-10 Guide
ICD-10 CodesM84.442

M84.442

Billable

Pathological fracture, left hand

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

Code Description

ICD-10 M84.442 is a billable code used to indicate a diagnosis of pathological fracture, left hand.

Key Diagnostic Point:

A pathological fracture of the left hand occurs when a bone in the hand breaks due to an underlying disease or condition that weakens the bone structure, rather than from a traumatic injury. Common causes include osteoporosis, metastatic cancer, or other bone density disorders that compromise bone integrity. Osteoporosis, characterized by decreased bone mass and deterioration of bone tissue, significantly increases the risk of fractures, particularly in older adults. In the case of the left hand, fractures may involve any of the bones, including the metacarpals or phalanges. 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 treatment of the underlying condition to prevent further fractures. Understanding the patient's history, including risk factors for osteoporosis or other metabolic bone diseases, 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 the underlying conditions contributing to the fracture
  • Documentation of bone density testing results
  • Potential for multiple fractures in different locations

Audit Risk Factors

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

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, patient history, and treatment plans must be documented.

Common Clinical Scenarios

Patients presenting with fractures due to osteoporosis or metastatic disease.

Billing Considerations

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

Endocrinology

Documentation Requirements

Bone density test results and management plans for osteoporosis must be included.

Common Clinical Scenarios

Patients with osteoporosis who experience fractures.

Billing Considerations

Documentation should include details on the patient's bone health and any treatments for osteoporosis.

Coding Guidelines

Inclusion Criteria

Use M84.442 When
  • According to ICD
  • 10 guidelines, M84
  • 442 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
  • impact injuries

Exclusion Criteria

Do NOT use M84.442 When
  • Exclusion criteria include fractures resulting from high

Related ICD-10 Codes

Related CPT Codes

20605CPT Code

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

Clinical Scenario

Used when a patient with a pathological fracture requires joint aspiration.

Documentation Requirements

Document the reason for the procedure and the findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is necessary for managing the fracture.

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 track and manage conditions like osteoporosis and their complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the ability to track and manage conditions like osteoporosis and their complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the ability to track and manage conditions like osteoporosis and their complications.

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 disease that weakens the bone, while a traumatic fracture results from an external force or injury.