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ICD-10 Guide
ICD-10 CodesM84.462

M84.462

Billable

Pathological fracture, left tibia

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

Code Description

ICD-10 M84.462 is a billable code used to indicate a diagnosis of pathological fracture, left tibia.

Key Diagnostic Point:

A pathological fracture of the left tibia 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 tibia, being a weight-bearing bone, is particularly vulnerable in individuals with compromised bone health. Diagnosis typically involves imaging studies such as X-rays or CT scans to confirm the fracture and assess the extent of the underlying bone pathology. Management may include pain control, stabilization of the fracture, and treatment of the underlying condition to prevent further 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 the underlying conditions contributing to bone fragility
  • Accurate documentation of the fracture's location and type
  • Potential for multiple comorbidities affecting bone health

Audit Risk Factors

  • Inadequate documentation of the underlying condition
  • Failure to specify the type of fracture (e.g., complete vs. incomplete)
  • Misclassification of the fracture as traumatic rather than pathological
  • Lack of imaging reports to support the diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, patient history, and treatment plans.

Common Clinical Scenarios

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

Billing Considerations

Documentation must clearly indicate the cause of the fracture and any underlying bone density issues.

Endocrinology

Documentation Requirements

Bone density test results, history of osteoporosis or other metabolic bone diseases.

Common Clinical Scenarios

Patients with osteoporosis experiencing fractures.

Billing Considerations

Documentation should include details on the management of the underlying bone density disorder.

Coding Guidelines

Inclusion Criteria

Use M84.462 When
  • According to ICD
  • 10 coding guidelines, M84
  • 462 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 or those not associated with a pathological condition

Exclusion Criteria

Do NOT use M84.462 When
  • Exclusion criteria include fractures resulting from high

Related ICD-10 Codes

Related CPT Codes

20610CPT 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 any imaging findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on the patient's condition.

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 contributing to bone health.

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 contributing to bone health.

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 contributing to bone health.

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.