ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesM84.56

M84.56

Billable

Pathological fracture in neoplastic disease, tibia and fibula

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

Code Description

ICD-10 M84.56 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, tibia and fibula.

Key Diagnostic Point:

Pathological fractures in neoplastic disease, specifically affecting the tibia and fibula, occur when bone integrity is compromised due to the presence of a tumor. These fractures are often a result of weakened bone structure due to the infiltration of cancer cells, which disrupt normal bone metabolism and density. Neoplastic diseases, such as metastatic cancer, can lead to osteolytic lesions that weaken the bone, making it susceptible to fractures even with minimal or no trauma. Patients with conditions like osteoporosis may also be at increased risk for such fractures, as their bone density is already compromised. Clinical management often involves addressing the underlying neoplastic condition, pain management, and potential surgical intervention to stabilize the fracture. Accurate coding of this condition is crucial for appropriate treatment planning and reimbursement, as it reflects the complexity of care required for patients with both cancer and skeletal complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

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 clinical evidence for the diagnosis.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of the neoplastic disease, imaging results, and treatment plans.

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Ensure that the primary cancer diagnosis is clearly documented to support the fracture coding.

Orthopedics

Documentation Requirements

Surgical notes, imaging studies, and post-operative care details.

Common Clinical Scenarios

Surgical intervention for stabilization of pathological fractures in cancer patients.

Billing Considerations

Document the extent of bone involvement and any prior treatments that may affect bone integrity.

Coding Guidelines

Inclusion Criteria

Use M84.56 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the underlying neoplastic disease is documented
  • Include any relevant imaging studies and clinical findings that support the diagnosis of a pathological fracture

Exclusion Criteria

Do NOT use M84.56 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 performed.

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 accuracy of data collection and reimbursement processes. M84.56 provides a clear indication of the relationship between neoplastic disease and fracture risk.

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. M84.56 provides a clear indication of the relationship between neoplastic disease and fracture risk.

Reimbursement & Billing Impact

reimbursement processes. M84.56 provides a clear indication of the relationship between neoplastic disease and fracture risk.

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.