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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.549

M84.549

Billable

Pathological fracture in neoplastic disease, unspecified hand

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

Code Description

ICD-10 M84.549 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, unspecified hand.

Key Diagnostic Point:

Pathological fractures in neoplastic disease occur when a bone breaks due to the weakening of the bone structure caused by a tumor. This can happen in various types of neoplastic diseases, including primary bone tumors and metastatic cancers that spread to the bone. The hand, being a complex structure with multiple small bones, can be particularly vulnerable to such fractures. Patients with neoplastic diseases often experience changes in bone metabolism, leading to decreased bone density and increased fragility. Osteoporosis, a condition characterized by reduced bone mass and deterioration of bone tissue, can further complicate the situation, making fractures more likely. The diagnosis of a pathological fracture in the hand requires careful imaging studies, such as X-rays or MRIs, to assess the extent of the fracture and the underlying neoplastic condition. Treatment typically involves addressing the fracture, managing the underlying cancer, and possibly utilizing orthopedic interventions to stabilize the affected area. Understanding the relationship between neoplastic diseases and bone health is crucial for effective management and coding of these conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary and metastatic neoplasms
  • Understanding the specific location of the fracture within the hand
  • Identifying the underlying neoplastic disease
  • Documenting the patient's bone density status

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease
  • Failure to specify the exact location of the fracture
  • Lack of imaging studies to support the diagnosis
  • Misclassification of the fracture type

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of the neoplastic disease, treatment history, and current status.

Common Clinical Scenarios

Patients with metastatic breast cancer presenting with hand fractures.

Billing Considerations

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

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients with primary bone tumors presenting with fractures in the hand.

Billing Considerations

Document the surgical interventions and any orthopedic devices used.

Coding Guidelines

Inclusion Criteria

Use M84.549 When
  • According to ICD
  • 10 guidelines, M84
  • 549 should be used when a pathological fracture occurs in the hand due to a neoplastic disease, and the specific type of neoplasm is not specified
  • Coders must ensure that the documentation supports the diagnosis and includes details about the fracture and the underlying condition

Exclusion Criteria

Do NOT use M84.549 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20605CPT 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 the procedure and the findings.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is linked to the diagnosis.

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 the accuracy of data collection and reimbursement processes. M84.549 provides a clear designation for fractures in the hand, facilitating better patient management and tracking of outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures related to neoplastic diseases, improving the accuracy of data collection and reimbursement processes. M84.549 provides a clear designation for fractures in the hand, facilitating better patient management and tracking of outcomes.

Reimbursement & Billing Impact

reimbursement processes. M84.549 provides a clear designation for fractures in the hand, facilitating better patient management and tracking of outcomes.

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 M84.549 and M84.548?

M84.549 is used for pathological fractures in neoplastic disease in an unspecified hand, while M84.548 is for fractures in other specified sites. The distinction is important for accurate coding based on the fracture's location.