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ICD-10 Guide
ICD-10 CodesM84.639

M84.639

Billable

Pathological fracture in other disease, unspecified ulna and radius

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

Code Description

ICD-10 M84.639 is a billable code used to indicate a diagnosis of pathological fracture in other disease, unspecified ulna and radius.

Key Diagnostic Point:

M84.639 refers to a pathological fracture occurring in the ulna and radius 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 ulna and radius, these fractures can significantly impact a patient's mobility and quality of life. Osteoporosis, a common condition characterized by decreased bone density, is a primary contributor to such fractures, particularly in older adults. Other conditions that may lead to pathological fractures include Paget's disease, osteogenesis imperfecta, and certain malignancies that metastasize to bone. Diagnosis typically involves imaging studies, such as X-rays or CT scans, to confirm the fracture and assess the underlying bone condition. Treatment may involve surgical intervention, such as fixation or stabilization, alongside management of the underlying disease to prevent further fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying diseases that can cause pathological fractures
  • Need for precise documentation of the underlying condition
  • Differentiation from traumatic fractures
  • Potential for multiple co-existing conditions affecting bone health

Audit Risk Factors

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

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of bone density tests and any treatments for osteoporosis.

Endocrinology

Documentation Requirements

Comprehensive assessment of metabolic bone diseases and their management.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders experiencing fractures.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use M84.639 When
  • According to ICD
  • 10 coding guidelines, M84
  • 639 should be used when a pathological fracture is confirmed, and the underlying disease is documented
  • It is essential to ensure that the fracture is not due to a traumatic event and that the specific location of the fracture is noted

Exclusion Criteria

Do NOT use M84.639 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 aspiration and any findings.

Specialty Considerations

Orthopedic specialists should ensure proper documentation of joint health.

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 track and manage conditions affecting bone health. M84.639 provides a clear classification for fractures due to underlying diseases, enhancing data accuracy for treatment and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pathological fractures, improving the ability to track and manage conditions affecting bone health. M84.639 provides a clear classification for fractures due to underlying diseases, enhancing data accuracy for treatment and research.

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 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 essential to differentiate between the two for accurate coding.