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ICD-10 Guide
ICD-10 CodesM84.573

M84.573

Billable

Pathological fracture in neoplastic disease, unspecified ankle

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

Code Description

ICD-10 M84.573 is a billable code used to indicate a diagnosis of pathological fracture in neoplastic disease, unspecified 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 the case of M84.573, the fracture is specifically located in the ankle region, but the exact nature of the neoplastic disease is unspecified. Such fractures are often associated with conditions like osteoporosis, where bone density is compromised, leading to increased fragility. Neoplastic diseases can disrupt normal bone metabolism, leading to osteolytic lesions that weaken the structural integrity of the bone. Patients with a history of cancer, particularly those with metastatic disease, are at higher risk for these types of fractures. The clinical presentation may include localized pain, swelling, and decreased mobility. Diagnosis typically involves imaging studies such as X-rays or MRIs to assess the fracture and the underlying bone condition. Treatment may involve surgical intervention, pain management, and addressing the underlying neoplastic disease to improve bone health and prevent further fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for precise documentation of the neoplastic disease type.
  • Differentiation between primary and secondary bone tumors.
  • Understanding of bone metabolism disorders and their impact on fracture risk.
  • Variability in clinical presentation and treatment approaches.

Audit Risk Factors

  • Insufficient documentation of the neoplastic disease.
  • Inconsistent clinical notes regarding fracture location.
  • Lack of imaging reports to support the diagnosis.
  • Failure to document treatment plans related to the fracture.

Specialty Focus

Medical Specialties

Oncology

Documentation Requirements

Detailed history of the neoplastic disease, including type, stage, and treatment history.

Common Clinical Scenarios

Patients with metastatic cancer presenting with bone pain and fractures.

Billing Considerations

Documentation should clearly link the fracture to the underlying neoplastic disease.

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Management of fractures in patients with known bone metastases.

Billing Considerations

Orthopedic notes should detail the surgical or non-surgical interventions performed.

Coding Guidelines

Inclusion Criteria

Use M84.573 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is supported by clinical documentation
  • Include details about the neoplastic disease and any relevant imaging studies
  • Ensure that the fracture is documented as pathological and related to the neoplastic condition

Exclusion Criteria

Do NOT use M84.573 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.

Documentation Requirements

Document the reason for the procedure and the findings.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between the procedure and the underlying 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 ability to capture the complexity of cases involving neoplastic diseases. M84.573 provides a means to document fractures that occur in the context of cancer, which is critical for treatment planning and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the ability to capture the complexity of cases involving neoplastic diseases. M84.573 provides a means to document fractures that occur in the context of cancer, which is critical for treatment planning and reimbursement.

Reimbursement & Billing Impact

reimbursement.

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 M84.573 and M84.570?

M84.573 specifies a pathological fracture in neoplastic disease at the ankle, while M84.570 is a more general code for pathological fractures without specifying the site.