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ICD-10 Guide
ICD-10 CodesM84.650

M84.650

Billable

Pathological fracture in other disease, pelvis

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

Code Description

ICD-10 M84.650 is a billable code used to indicate a diagnosis of pathological fracture in other disease, pelvis.

Key Diagnostic Point:

A pathological fracture in the pelvis occurs when a bone breaks due to an underlying disease process rather than from trauma. This type of fracture is often associated with conditions that affect bone density and metabolism, such as osteoporosis, metastatic cancer, or other metabolic bone diseases. Osteoporosis, characterized by decreased bone mass and deterioration of bone tissue, significantly increases the risk of fractures, particularly in the pelvis, which bears much of the body's weight. Patients with osteoporosis may experience fractures from minimal trauma, such as a fall from standing height. Other diseases that can lead to pathological fractures include Paget's disease, osteogenesis imperfecta, and certain endocrine disorders. Diagnosis typically involves imaging studies, such as X-rays or CT scans, to confirm the fracture and assess the underlying bone condition. Management may include pain control, stabilization of the fracture, and treatment of the underlying disease to improve bone health and prevent future 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 comorbidities affecting bone health

Audit Risk Factors

  • Inadequate documentation of the underlying disease
  • Failure to specify the type of fracture
  • Misclassification of traumatic vs. pathological fractures
  • Lack of imaging studies to support the diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with hip pain and a history of osteoporosis or cancer.

Billing Considerations

Ensure imaging results are included in documentation to support the diagnosis.

Endocrinology

Documentation Requirements

Comprehensive assessment of metabolic bone disease and treatment plans.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders experiencing fractures.

Billing Considerations

Document the patient's bone density status and any treatments for underlying conditions.

Coding Guidelines

Inclusion Criteria

Use M84.650 When
  • According to ICD
  • 10 guidelines, M84
  • 650 should be used when a fracture occurs due to an underlying disease process
  • Coders must ensure that the underlying condition is documented and that the fracture is not due to trauma
  • energy trauma

Exclusion Criteria

Do NOT use M84.650 When
  • Exclusion criteria include fractures resulting from high

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 pelvic fracture requires joint aspiration for pain relief.

Documentation Requirements

Document the reason for the procedure and the patient's condition.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on the patient's fracture status.

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 and the underlying conditions affecting bone health.

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 and the underlying conditions affecting bone health.

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 and the underlying conditions affecting bone health.

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 an underlying disease that weakens the bone, while a traumatic fracture results from an external force or injury.