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ICD-10 Guide
ICD-10 CodesM84.473

M84.473

Billable

Pathological fracture, unspecified ankle

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

Code Description

ICD-10 M84.473 is a billable code used to indicate a diagnosis of pathological fracture, unspecified ankle.

Key Diagnostic Point:

A pathological fracture of the ankle occurs when a bone breaks in response to a disease process rather than due to trauma. This type of fracture is often associated with underlying conditions such as osteoporosis, osteogenesis imperfecta, or metastatic bone disease, which compromise bone density and structural integrity. In patients with osteoporosis, for instance, the bones become porous and brittle, making them susceptible to fractures even with minimal or no trauma. The ankle is a common site for such fractures due to its weight-bearing function and the stress it endures during daily activities. Diagnosis typically involves imaging studies, such as X-rays or MRIs, to confirm the fracture and assess the extent of any underlying bone density disorder. Treatment may include immobilization, pain management, and addressing the underlying condition to prevent future fractures. Understanding the etiology of the fracture is crucial for effective management and prevention strategies, particularly in populations at risk, such as the elderly or those with chronic diseases affecting bone metabolism.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying conditions leading to pathological fractures.
  • Need for precise documentation of the cause of the fracture.
  • Differentiation from traumatic fractures.
  • 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., stress vs. complete).
  • Misclassification of the fracture as traumatic.
  • Lack of follow-up documentation on treatment and outcomes.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, treatment plans, and follow-up notes.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, elderly patients with osteoporosis.

Billing Considerations

Ensure documentation reflects the underlying cause of the fracture for accurate coding.

Endocrinology

Documentation Requirements

Bone density test results, history of metabolic bone disease.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders experiencing fractures.

Billing Considerations

Documenting the patient's bone health status and treatment for osteoporosis is crucial.

Coding Guidelines

Inclusion Criteria

Use M84.473 When
  • According to ICD
  • 10 guidelines, M84
  • 473 should be used when the fracture is confirmed as pathological and the specific cause is not documented
  • Coders should ensure that the medical record supports the diagnosis and that any underlying conditions are also coded appropriately

Exclusion Criteria

Do NOT use M84.473 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.

Documentation Requirements

Document the indication for the procedure and the findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is linked to the diagnosis of 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. This specificity aids in better patient care 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 track and manage conditions like osteoporosis. This specificity aids in better patient care and resource allocation.

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. This specificity aids in better patient care and resource allocation.

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