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ICD-10 Guide
ICD-10 CodesM84.533

M84.533

Billable

Pathological fracture in neoplastic disease, right radius

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

Code Description

ICD-10 M84.533 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, right radius.

Key Diagnostic Point:

A pathological fracture in the context of neoplastic disease occurs when a bone breaks due to the weakening of the bone structure caused by a tumor or cancerous growth. In this case, the fracture is specifically located in the right radius, which is one of the two bones in the forearm. Neoplastic diseases can lead to bone density disorders, such as osteoporosis, where the integrity of the bone is compromised. This can result from direct invasion of the bone by a tumor or from the effects of systemic disease processes, including metastatic cancer. The presence of a neoplasm can disrupt normal bone metabolism, leading to increased osteoclastic activity and decreased osteoblastic activity, which further weakens the bone. Patients with such fractures often present with pain, swelling, and limited mobility in the affected area. Diagnosis typically involves imaging studies, such as X-rays or MRI, to confirm the fracture and assess the extent of the underlying neoplastic disease. Treatment may involve surgical intervention, pain management, and addressing the underlying cancer.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their effects on bone health.
  • Differentiation from other types of fractures, such as traumatic fractures.
  • Need for precise documentation of the neoplastic condition.
  • Potential for multiple underlying conditions affecting bone density.

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 studies in the medical record.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Ensure that the primary cancer diagnosis is clearly linked to the fracture.

Orthopedics

Documentation Requirements

Comprehensive assessment of the fracture, including imaging results and treatment plans.

Common Clinical Scenarios

Management of fractures in patients with known malignancies.

Billing Considerations

Document the mechanism of injury and any prior treatments affecting bone health.

Coding Guidelines

Inclusion Criteria

Use M84.533 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the neoplastic disease is documented and that the fracture is classified correctly as pathological
  • Include any relevant imaging and treatment notes

Exclusion Criteria

Do NOT use M84.533 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 pain relief.

Documentation Requirements

Document the indication 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 cases involving neoplastic diseases. This specificity aids in better tracking of outcomes 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 complexity of cases involving neoplastic diseases. This specificity aids in better tracking of outcomes and resource allocation.

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 cases involving neoplastic diseases. This specificity aids in better tracking of outcomes 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 weakened bone structure from disease, such as cancer, while a traumatic fracture results from an external force or injury.