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ICD-10 Guide
ICD-10 CodesM84.53

M84.53

Billable

Pathological fracture in neoplastic disease, ulna and radius

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

Code Description

ICD-10 M84.53 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, ulna and radius.

Key Diagnostic Point:

Pathological fractures in neoplastic disease, particularly affecting the ulna and radius, occur when bone integrity is compromised due to the presence of a tumor, either benign or malignant. These fractures are often the result of weakened bone structure due to the infiltration of neoplastic cells, which disrupt normal bone metabolism and density. Patients with conditions such as metastatic cancer, multiple myeloma, or primary bone tumors may experience these types of fractures. The ulna and radius, being long bones of the forearm, are particularly susceptible to pathological fractures due to their role in weight-bearing and movement. Symptoms typically include localized pain, swelling, and decreased range of motion. Diagnosis is confirmed through imaging studies such as X-rays or MRI, which reveal the fracture and any underlying neoplastic changes. Management may involve surgical intervention, pain management, and treatment of the underlying neoplastic disease to improve bone health and prevent further fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their impact on bone health.
  • Differentiation between pathological fractures and traumatic fractures.
  • Need for precise documentation of the underlying neoplastic condition.
  • Potential for multiple coding scenarios based on the type of neoplasm.

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease.
  • Failure to specify the location of the fracture accurately.
  • Misclassification of the fracture type (pathological vs. traumatic).
  • Lack of supporting imaging documentation.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of the cancer diagnosis, treatment history, and any imaging studies.

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Ensure accurate coding of both the neoplasm and the fracture to reflect the patient's condition.

Orthopedics

Documentation Requirements

Comprehensive notes on fracture assessment, treatment plans, and follow-up care.

Common Clinical Scenarios

Management of fractures in patients with known malignancies.

Billing Considerations

Collaboration with oncology for accurate coding and treatment planning.

Coding Guidelines

Inclusion Criteria

Use M84.53 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the underlying neoplastic disease is documented
  • Include any relevant imaging studies and treatment plans in the patient's medical record to support the diagnosis

Exclusion Criteria

Do NOT use M84.53 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 for pain management in patients with pathological fractures.

Documentation Requirements

Document the indication for the procedure and any imaging studies.

Specialty Considerations

Orthopedic specialists may perform this procedure in conjunction with fracture management.

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 accuracy of data collection and reimbursement processes. M84.53 provides a clear distinction between fractures due to neoplastic disease and other types of fractures.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the accuracy of data collection and reimbursement processes. M84.53 provides a clear distinction between fractures due to neoplastic disease and other types of fractures.

Reimbursement & Billing Impact

reimbursement processes. M84.53 provides a clear distinction between fractures due to neoplastic disease and other types of fractures.

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 in a bone weakened by disease, such as cancer, while a traumatic fracture results from an external force or injury.