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ICD-10 Guide
ICD-10 CodesM84.564

M84.564

Billable

Pathological fracture in neoplastic disease, left fibula

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

Code Description

ICD-10 M84.564 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, left fibula.

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 fibula. Neoplastic diseases can lead to alterations in bone metabolism, resulting in decreased bone density and structural integrity. This can occur due to direct invasion of the bone by a tumor or as a consequence of systemic effects of cancer, such as osteolysis. Patients with neoplastic diseases often have compromised bone health, making them more susceptible to fractures even with minimal trauma. The left fibula, being a non-weight-bearing bone, may not be as commonly fractured as weight-bearing bones, but when it does fracture, it can significantly impact mobility and quality of life. Management of such fractures typically involves addressing the underlying neoplastic condition, pain management, and rehabilitation to restore function. Accurate coding of this condition is crucial for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of neoplastic diseases and their effects on bone health.
  • Differentiation between primary and secondary neoplasms may be necessary.
  • Documentation must specify the location and nature of the fracture.
  • Potential for multiple underlying conditions affecting bone density.

Audit Risk Factors

  • Inadequate documentation of the neoplastic disease.
  • Failure to specify the exact location of the fracture.
  • Lack of clarity on the type of neoplasm (benign vs malignant).
  • Insufficient details on the patient's bone health status.

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

Need for interdisciplinary communication regarding treatment plans and potential surgical interventions.

Orthopedics

Documentation Requirements

Specific details about the fracture, including imaging results and treatment plans.

Common Clinical Scenarios

Management of fractures in patients with known malignancies or those undergoing chemotherapy.

Billing Considerations

Consideration of surgical options and rehabilitation needs.

Coding Guidelines

Inclusion Criteria

Use M84.564 When
  • According to ICD
  • 10 guidelines, M84
  • 564 should be used when a pathological fracture is confirmed in a patient with a documented neoplastic disease
  • It is essential to ensure that the documentation supports the diagnosis of both the fracture and the underlying condition

Exclusion Criteria

Do NOT use M84.564 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 reason for the procedure and the findings.

Specialty Considerations

Orthopedic specialists may perform this procedure in conjunction with fracture management.

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. M84.564 provides a clear indication of the relationship between the fracture and the underlying disease, which is essential for treatment planning.

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. M84.564 provides a clear indication of the relationship between the fracture and the underlying disease, which is essential for treatment planning.

Reimbursement & Billing Impact

reimbursement processes. M84.564 provides a clear indication of the relationship between the fracture and the underlying disease, which is essential for treatment planning.

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 that is weakened by disease, such as cancer, while a traumatic fracture results from an external force or injury. Pathological fractures can occur with minimal or no trauma, whereas traumatic fractures typically require significant force.