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ICD-10 Guide
ICD-10 CodesM84.463

M84.463

Billable

Pathological fracture, right fibula

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

Code Description

ICD-10 M84.463 is a billable code used to indicate a diagnosis of pathological fracture, right fibula.

Key Diagnostic Point:

A pathological fracture of the right fibula 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 that weaken bone integrity, such as osteoporosis, metastatic cancer, or other metabolic bone disorders. In patients with osteoporosis, the bone density is significantly reduced, making bones more susceptible to fractures even with minimal or no trauma. The fibula, being a non-weight-bearing bone, can be affected by these conditions, leading to fractures that may not be immediately apparent. Symptoms may include localized pain, swelling, and difficulty bearing weight on the affected leg. Diagnosis typically involves imaging studies such as X-rays or MRI to confirm the fracture and assess the underlying bone condition. Management may include pain control, immobilization, and treatment of the underlying bone density disorder 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
  • Identifying underlying conditions contributing to bone weakness
  • Documentation of the patient's history of osteoporosis or other metabolic disorders
  • Need for imaging studies to confirm the diagnosis

Audit Risk Factors

  • Inadequate documentation of the underlying bone disorder
  • Failure to specify the type of fracture (e.g., acute vs. chronic)
  • 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 documentation of fracture type, location, and underlying conditions; imaging results; treatment plan.

Common Clinical Scenarios

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

Billing Considerations

Orthopedic surgeons should ensure that the etiology of the fracture is clearly documented to support the use of M84.463.

Endocrinology

Documentation Requirements

Comprehensive assessment of bone density, history of metabolic bone disease, and treatment plans for osteoporosis.

Common Clinical Scenarios

Patients with osteoporosis presenting with fractures, requiring management of bone health.

Billing Considerations

Endocrinologists should document the patient's bone density status and any treatments that may affect fracture risk.

Coding Guidelines

Inclusion Criteria

Use M84.463 When
  • According to ICD
  • 10 coding guidelines, M84
  • 463 should be used when a pathological fracture is confirmed and the underlying condition is documented
  • Coders must ensure that the fracture is not due to trauma and that the patient's history supports the diagnosis of a pathological fracture

Exclusion Criteria

Do NOT use M84.463 When
No specific exclusions found.

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 for swelling.

Documentation Requirements

Document the reason for the procedure, the joint involved, and any imaging performed.

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 underlying conditions that contribute to these fractures. 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 underlying conditions that contribute to these fractures. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

reimbursement and to avoid 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 an underlying disease that weakens the bone, while a traumatic fracture results from an external force or injury.