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ICD-10 Guide
ICD-10 CodesM84.479

M84.479

Billable

Pathological fracture, unspecified toe(s)

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

Code Description

ICD-10 M84.479 is a billable code used to indicate a diagnosis of pathological fracture, unspecified toe(s).

Key Diagnostic Point:

A pathological fracture of the toe(s) occurs when a bone breaks in response to a disease process rather than due to an external force. This can be associated with conditions such as osteoporosis, which is characterized by decreased bone density and increased fragility. Pathological fractures can also arise from metabolic bone disorders, malignancies, or infections that weaken the bone structure. In the case of unspecified toes, the fracture may involve any of the phalanges or metatarsals without specification, complicating the clinical picture. Patients may present with pain, swelling, and difficulty in ambulation. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the underlying bone condition. Treatment may include pain management, immobilization, and addressing the underlying bone density disorder to prevent future fractures. Understanding the etiology of the fracture is crucial for effective management and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified nature of the fracture complicates coding.
  • Requires knowledge of underlying conditions like osteoporosis.
  • Differentiating between traumatic and pathological fractures.
  • Potential for multiple fractures in the same patient.

Audit Risk Factors

  • Inadequate documentation of the underlying bone disorder.
  • Failure to specify the affected toe(s).
  • Misclassification as a traumatic fracture.
  • Lack of imaging documentation to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture location, type, and underlying conditions.

Common Clinical Scenarios

Patients with osteoporosis presenting with toe fractures.

Billing Considerations

Ensure imaging results are included in the documentation.

Endocrinology

Documentation Requirements

Assessment of bone density and metabolic conditions.

Common Clinical Scenarios

Patients with metabolic bone diseases leading to fractures.

Billing Considerations

Document any treatments for osteoporosis or related conditions.

Coding Guidelines

Inclusion Criteria

Use M84.479 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant history of osteoporosis or other bone density disorders

Exclusion Criteria

Do NOT use M84.479 When
  • Exclude codes for traumatic fractures unless specified

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

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

Clinical Scenario

Used when joint aspiration is needed due to swelling from a pathological fracture.

Documentation Requirements

Document the reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists may perform this procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, including the differentiation between traumatic and pathological fractures, which enhances the accuracy of patient records and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the differentiation between traumatic and pathological fractures, which enhances the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, including the differentiation between traumatic and pathological fractures, which enhances the accuracy of patient records and treatment plans.

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