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ICD-10 Guide
ICD-10 CodesM84.45

M84.45

Billable

Pathological fracture, femur and pelvis

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

Code Description

ICD-10 M84.45 is a billable code used to indicate a diagnosis of pathological fracture, femur and pelvis.

Key Diagnostic Point:

A pathological fracture of the femur and pelvis occurs when these bones break due to underlying conditions that weaken bone integrity, rather than from a traumatic injury. Common causes include osteoporosis, metastatic cancer, and other bone density disorders. Osteoporosis, characterized by reduced bone mass and deterioration of bone tissue, significantly increases the risk of fractures, particularly in older adults. In patients with osteoporosis, even minor falls or stresses can lead to fractures. The femur, being the longest bone in the body, and the pelvis, which supports the weight of the upper body, are particularly vulnerable. 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, stabilization of the fracture, and treatment of the underlying condition to improve bone density and prevent future fractures. Understanding the relationship between bone metabolism and fracture risk is crucial for effective treatment and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between traumatic and pathological fractures
  • Identifying underlying conditions contributing to bone weakness
  • Documentation of prior bone density assessments
  • Understanding the implications of co-morbidities such as osteoporosis

Audit Risk Factors

  • Inadequate documentation of the underlying condition
  • Failure to specify the type of fracture (e.g., displaced vs. non-displaced)
  • Lack of imaging reports to support the diagnosis
  • Inconsistent coding of co-morbidities

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, notes on fracture type, and underlying conditions.

Common Clinical Scenarios

Patients presenting with hip pain after minimal trauma, elderly patients with a history of falls.

Billing Considerations

Ensure accurate documentation of bone density tests and any treatments for osteoporosis.

Endocrinology

Documentation Requirements

Bone density test results, treatment plans for osteoporosis, and patient history.

Common Clinical Scenarios

Patients with osteoporosis presenting with fractures, monitoring patients on long-term corticosteroids.

Billing Considerations

Documenting the impact of hormonal imbalances on bone health.

Coding Guidelines

Inclusion Criteria

Use M84.45 When
  • According to ICD
  • 10 guidelines, M84
  • 45 should be used when a fracture occurs due to an underlying pathological condition
  • Coders must ensure that the underlying condition is documented and coded appropriately

Exclusion Criteria

Do NOT use M84.45 When
  • Exclusion criteria include fractures resulting from trauma or accidents

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

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

Clinical Scenario

Used for joint pain management in patients with fractures.

Documentation Requirements

Document the joint involved and the reason for the procedure.

Specialty Considerations

Orthopedic specialists may perform this procedure for pain relief.

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, while a traumatic fracture results from an external force or injury.