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ICD-10 Guide
ICD-10 CodesM84.619

M84.619

Billable

Pathological fracture in other disease, unspecified shoulder

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

Code Description

ICD-10 M84.619 is a billable code used to indicate a diagnosis of pathological fracture in other disease, unspecified shoulder.

Key Diagnostic Point:

M84.619 refers to a pathological fracture occurring in the shoulder region due to underlying diseases that affect bone density and metabolism, such as osteoporosis, malignancies, or metabolic bone disorders. Pathological fractures are fractures that occur in bones weakened by disease rather than by trauma. In the case of the shoulder, these fractures can significantly impact mobility and quality of life. Osteoporosis, a common condition characterized by decreased bone density, is often a primary contributor to such fractures, particularly in older adults. Other conditions, such as Paget's disease or metastatic cancer, can also lead to weakened bone structures, increasing the risk of fractures. Diagnosis typically involves imaging studies, such as X-rays or MRIs, to confirm the fracture and assess the extent of bone involvement. Treatment may include pain management, physical therapy, and in some cases, surgical intervention. Accurate coding is essential for proper reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying diseases that can lead to pathological fractures
  • Need for precise documentation of the underlying condition
  • Differentiation from traumatic fractures
  • Potential for multiple comorbidities affecting bone health

Audit Risk Factors

  • Inadequate documentation of the underlying disease
  • Failure to specify the location of the fracture
  • Misclassification of the fracture type (pathological vs. traumatic)
  • Lack of supporting imaging reports

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture type, location, and underlying conditions affecting bone health.

Common Clinical Scenarios

Patients presenting with fractures due to osteoporosis or other metabolic bone diseases.

Billing Considerations

Ensure that all relevant imaging and lab results are included to support the diagnosis.

Endocrinology

Documentation Requirements

Comprehensive evaluation of metabolic bone disorders, including lab results and treatment plans.

Common Clinical Scenarios

Patients with osteoporosis or other endocrine disorders leading to bone fragility.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use M84.619 When
  • According to ICD
  • 10 coding guidelines, M84
  • 619 should be used when a pathological fracture occurs in the shoulder due to an unspecified underlying disease
  • Coders must ensure that the underlying condition is documented clearly to support the use of this code

Exclusion Criteria

Do NOT use M84.619 When
  • Exclusion criteria include fractures resulting from trauma or those that can be classified under other specific fracture codes

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 diagnostic or therapeutic purposes.

Documentation Requirements

Document the reason for the procedure, including the patient's history of bone disease.

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, enabling better tracking of conditions affecting bone health and improving the accuracy of reimbursement for related services.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, enabling better tracking of conditions affecting bone health and improving the accuracy of reimbursement for related services.

Reimbursement & Billing Impact

reimbursement for related services.

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, while a traumatic fracture results from an external force or injury. Proper documentation is crucial to differentiate between the two for accurate coding.