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ICD-10 Guide
ICD-10 CodesM84.65

M84.65

Billable

Pathological fracture in other disease, pelvis and femur

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

Code Description

ICD-10 M84.65 is a billable code used to indicate a diagnosis of pathological fracture in other disease, pelvis and femur.

Key Diagnostic Point:

Pathological fractures occur when bones break due to underlying diseases rather than from trauma. In the case of M84.65, the fractures specifically affect the pelvis and femur, which are critical weight-bearing bones. Conditions such as osteoporosis, osteomalacia, and metastatic bone disease can lead to decreased bone density and compromised bone integrity, making these bones more susceptible to fractures even with minimal or no trauma. Osteoporosis, characterized by reduced bone mass and deterioration of bone tissue, is a common cause of such fractures, particularly in older adults. The risk factors for these fractures include age, gender (with women being more affected), family history, and lifestyle factors such as smoking and physical inactivity. Diagnosis typically involves imaging studies like X-rays or CT scans to confirm the fracture and assess the extent of bone loss. Management may include pain control, stabilization of the fracture, and treatment of the underlying condition to prevent further fractures. Understanding the relationship between bone metabolism disorders and pathological fractures is crucial for effective treatment and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between traumatic and pathological fractures
  • Identifying the underlying disease causing the fracture
  • Documenting the specific location and type of fracture
  • Understanding the patient's medical history related to bone health

Audit Risk Factors

  • Inadequate documentation of the underlying disease
  • Failure to specify the location of the fracture
  • Misclassification of the fracture type
  • Lack of supporting imaging documentation

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, surgical notes, and patient history related to bone health.

Common Clinical Scenarios

Patients presenting with hip or femur fractures due to osteoporosis or metastatic disease.

Billing Considerations

Ensure that the underlying condition is clearly documented to support the diagnosis of a pathological fracture.

Endocrinology

Documentation Requirements

Comprehensive evaluation of bone density tests and metabolic assessments.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Documenting the patient's hormonal status and any treatments affecting bone metabolism.

Coding Guidelines

Inclusion Criteria

Use M84.65 When
  • According to ICD
  • 10 guidelines, M84
  • 65 should be used when a pathological fracture occurs in the pelvis or femur due to an underlying disease
  • Coders must ensure that the underlying condition is documented and that the fracture is not due to trauma

Exclusion Criteria

Do NOT use M84.65 When
  • Exclusion criteria include fractures resulting from accidents or falls without 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 joint injections in patients with fractures.

Documentation Requirements

Document the joint involved and the reason for the procedure.

Specialty Considerations

Orthopedic specialists should ensure the fracture is documented to justify the procedure.

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 related to bone health. M84.65 provides a clear distinction between fractures due to underlying diseases and those resulting from trauma.

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 related to bone health. M84.65 provides a clear distinction between fractures due to underlying diseases and those resulting from trauma.

Reimbursement & Billing Impact

reimbursement and to avoid claim denials.

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 due to underlying diseases that weaken the bone, while a traumatic fracture results from an external force or injury.