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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.534

M84.534

Billable

Pathological fracture in neoplastic disease, left radius

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

Code Description

ICD-10 M84.534 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, left radius.

Key Diagnostic Point:

A pathological fracture in the context of neoplastic disease refers to a fracture that occurs in a bone weakened by the presence of a tumor, either benign or malignant. In this case, the fracture is specifically located in the left radius, which is one of the two bones in the forearm. Neoplastic diseases can lead to bone density disorders, such as osteoporosis, by disrupting normal bone metabolism and remodeling processes. The presence of a tumor can cause local bone destruction, leading to a significant reduction in bone strength and an increased risk of fractures. Patients with neoplastic diseases may experience pathological fractures even with minimal trauma or stress to the bone, which would not typically cause a fracture in a healthy individual. Accurate coding of this condition is crucial for appropriate treatment planning, resource allocation, and understanding the patient's overall health status. Documentation should include details about the type of neoplasm, the location and nature of the fracture, and any relevant history of bone density disorders or previous fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for precise documentation of the neoplastic disease type
  • Differentiation between primary and secondary tumors
  • Understanding of bone metabolism and its impact on fracture risk
  • Potential for multiple fractures in different locations

Audit Risk Factors

  • Inadequate documentation of the neoplasm type
  • Failure to specify the location of the fracture
  • Misclassification of the fracture as traumatic rather than pathological
  • Lack of supporting imaging or clinical notes

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of the neoplasm, including type, stage, and treatment history.

Common Clinical Scenarios

Patients with metastatic cancer presenting with fractures due to bone involvement.

Billing Considerations

Ensure that the relationship between the neoplasm and the fracture is clearly documented.

Orthopedics

Documentation Requirements

Radiological findings, fracture details, and any surgical interventions performed.

Common Clinical Scenarios

Management of fractures in patients with known malignancies affecting bone integrity.

Billing Considerations

Document the mechanism of injury and any prior fractures or treatments.

Coding Guidelines

Inclusion Criteria

Use M84.534 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the neoplastic disease is documented and that the fracture is confirmed as pathological
  • Include any relevant history of osteoporosis or other bone density disorders

Exclusion Criteria

Do NOT use M84.534 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 reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists should ensure that the fracture's relationship to the neoplasm is documented.

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 related to neoplastic diseases, improving data accuracy and patient care management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures related to neoplastic diseases, improving data accuracy and patient care management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pathological fractures related to neoplastic diseases, improving data accuracy and patient care management.

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.