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ICD-10 Guide
ICD-10 CodesM84.571

M84.571

Billable

Pathological fracture in neoplastic disease, right ankle

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

Code Description

ICD-10 M84.571 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, right ankle.

Key Diagnostic Point:

A pathological fracture in 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 right ankle. Neoplastic diseases can lead to bone density disorders, such as osteoporosis, due to the disruption of normal bone metabolism. The presence of a tumor can compromise the structural integrity of the bone, making it more susceptible to fractures even with minimal or no trauma. Patients with neoplastic diseases often experience pain, swelling, and decreased mobility in the affected area. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to assess the fracture and the underlying neoplastic condition. Treatment may include surgical intervention, radiation therapy, or chemotherapy, depending on the type and stage of the neoplasm. 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 impact on bone health.
  • Differentiation between pathological fractures and traumatic fractures.
  • Need for precise documentation of 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.
  • Misclassification of the fracture type (pathological vs. traumatic).
  • Lack of supporting imaging studies in the medical record.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed documentation of the neoplasm type, location, and treatment plan.

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Ensure that the neoplastic disease is clearly documented to support the diagnosis of a pathological fracture.

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients with a history of cancer presenting with fractures after minimal trauma.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use M84.571 When
  • According to ICD
  • 10 coding guidelines, M84
  • 571 should be used when a fracture is confirmed to be pathological due to a neoplastic disease
  • Coders must ensure that the underlying neoplasm is documented and that the fracture is not due to trauma

Exclusion Criteria

Do NOT use M84.571 When
  • Exclusion criteria include fractures that are purely traumatic without any underlying disease

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 linked to the diagnosis of the pathological fracture.

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 patient records and facilitating better 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 patient records and facilitating better treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pathological fractures related to neoplastic diseases, improving the accuracy of patient records and facilitating better 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 weakened by disease, such as a neoplasm, while a traumatic fracture results from an external force or injury.