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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.60

M84.60

Billable

Pathological fracture in other disease, unspecified site

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

Code Description

ICD-10 M84.60 is a billable code used to indicate a diagnosis of pathological fracture in other disease, unspecified site.

Key Diagnostic Point:

Pathological fractures occur when bones break due to underlying diseases rather than from trauma. This code, M84.60, is used when a fracture is identified but the specific site of the fracture is not documented. Common underlying conditions leading to pathological fractures include osteoporosis, osteogenesis imperfecta, Paget's disease, and metastatic bone disease. Osteoporosis, characterized by decreased bone density and quality, significantly increases the risk of fractures, particularly in the elderly. These fractures can occur with minimal or no trauma, often referred to as 'fragility fractures.' The management of pathological fractures involves addressing the underlying disease, which may include pharmacological treatments to improve bone density, physical therapy, and in some cases, surgical intervention. Accurate coding is crucial for proper treatment planning and reimbursement, as it reflects the complexity of the patient's condition and the necessity for comprehensive care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of fracture sites
  • Need for comprehensive understanding of underlying diseases
  • Differentiation from traumatic fractures
  • Potential for multiple underlying conditions

Audit Risk Factors

  • Inadequate documentation of the underlying disease
  • Failure to specify fracture site when known
  • Misclassification of traumatic vs. pathological fractures
  • Inconsistent coding practices across providers

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture location, type, and underlying conditions.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, often in older adults.

Billing Considerations

Ensure clear documentation of the patient's bone health status and any treatments for underlying conditions.

Endocrinology

Documentation Requirements

Comprehensive assessment of bone density and metabolic disorders.

Common Clinical Scenarios

Patients with osteoporosis or metabolic bone diseases experiencing fractures.

Billing Considerations

Document any hormonal treatments or interventions that may affect bone density.

Coding Guidelines

Inclusion Criteria

Use M84.60 When
  • Follow the ICD
  • CM coding guidelines for reporting pathological fractures
  • Ensure that the underlying disease is documented and that the fracture is not due to trauma
  • Use additional codes to specify the underlying condition when applicable

Exclusion Criteria

Do NOT use M84.60 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 in conjunction with M84.60 when joint aspiration is needed due to fracture complications.

Documentation Requirements

Document the reason for aspiration and any findings.

Specialty Considerations

Orthopedic specialists should ensure clear documentation of the fracture and its 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, improving the ability to capture the complexity of these cases. M84.60 provides a mechanism to code fractures that occur due to underlying diseases, which may have been less clearly defined in ICD-9.

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 these cases. M84.60 provides a mechanism to code fractures that occur due to underlying diseases, which may have been less clearly defined in ICD-9.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the ability to capture the complexity of these cases. M84.60 provides a mechanism to code fractures that occur due to underlying diseases, which may have been less clearly defined in ICD-9.

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

When should I use M84.60?

Use M84.60 when a pathological fracture is documented, but the specific site of the fracture is not specified. Ensure that the underlying disease is also documented.