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ICD-10 Guide
ICD-10 CodesM84.55

M84.55

Billable

Pathological fracture in neoplastic disease, pelvis and femur

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

Code Description

ICD-10 M84.55 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, pelvis and femur.

Key Diagnostic Point:

Pathological fractures in neoplastic disease, particularly in the pelvis and femur, occur when a bone weakened by cancer or metastatic disease breaks under normal stress or minimal trauma. These fractures are often associated with conditions such as osteoporosis, where bone density is significantly reduced, leading to increased fragility. In patients with neoplastic diseases, the cancer can directly invade the bone or cause changes in bone metabolism that weaken the structural integrity of the bone. This can result in fractures that may not occur in healthy bone. The pelvis and femur are common sites for these fractures due to their weight-bearing function and the stress they endure during daily activities. Diagnosis typically involves imaging studies such as X-rays or MRI to confirm the presence of a fracture and assess the extent of bone involvement. Management may include surgical intervention, pain management, and treatment of the underlying neoplastic disease. Understanding the interplay between cancer, bone density disorders, and fracture risk is crucial for effective treatment and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary and metastatic neoplastic disease
  • Identifying the specific site of the fracture (pelvis vs. femur)
  • Documenting the underlying neoplastic condition accurately
  • Understanding the implications of bone density disorders

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease
  • Failure to specify the fracture site
  • Misclassification of the fracture type
  • Lack of supporting imaging documentation

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

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

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.

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients with pathological fractures requiring surgical intervention.

Billing Considerations

Document the mechanism of injury and any pre-existing bone conditions.

Coding Guidelines

Inclusion Criteria

Use M84.55 When
  • According to ICD
  • 10 guidelines, M84
  • 55 should be used when a pathological fracture is confirmed in a patient with a documented neoplastic disease
  • It is essential to include the specific site of the fracture and any relevant details about the neoplasm

Exclusion Criteria

Do NOT use M84.55 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27447CPT Code

Total hip arthroplasty

Clinical Scenario

Used in cases where a pathological fracture of the femur requires surgical intervention.

Documentation Requirements

Operative report detailing the procedure and indication for surgery.

Specialty Considerations

Orthopedic surgeons must document the fracture type and underlying neoplastic disease.

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.

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.

Reimbursement & Billing Impact

reimbursement processes.

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.