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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.659

M84.659

Billable

Pathological fracture in other disease, hip, unspecified

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

Code Description

ICD-10 M84.659 is a billable code used to indicate a diagnosis of pathological fracture in other disease, hip, unspecified.

Key Diagnostic Point:

A pathological fracture is a break in a bone that occurs due to a disease process rather than from an external force. In the case of M84.659, the fracture is specifically located in the hip and is classified as unspecified, indicating that the underlying disease causing the fracture is not detailed. Common conditions leading to such fractures include osteoporosis, metastatic cancer, osteogenesis imperfecta, and other metabolic bone diseases. Osteoporosis, characterized by decreased bone density and quality, significantly increases the risk of fractures, particularly in the hip region, which is a common site for such injuries. The hip is particularly vulnerable due to its weight-bearing function and the stresses placed upon it during daily activities. Patients with underlying conditions affecting bone metabolism may experience fractures with minimal or no trauma, highlighting the importance of early diagnosis and management of bone density disorders. Treatment often involves addressing the underlying disease, pain management, and rehabilitation to restore mobility and function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in underlying disease processes leading to fractures
  • Need for precise documentation of the cause of the fracture
  • Differentiation from other types of fractures
  • Potential for multiple comorbidities affecting coding

Audit Risk Factors

  • Inadequate documentation of the underlying disease
  • Failure to specify the type of fracture
  • Inconsistent coding practices among providers
  • Lack of clarity in clinical notes regarding the fracture mechanism

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes on fracture type, mechanism, and underlying conditions.

Common Clinical Scenarios

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

Billing Considerations

Ensure that the underlying disease is documented to support the use of M84.659.

Endocrinology

Documentation Requirements

Comprehensive evaluation of bone density and metabolic disorders.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone diseases experiencing fractures.

Billing Considerations

Documenting the patient's bone density status and treatment history is crucial.

Coding Guidelines

Inclusion Criteria

Use M84.659 When
  • According to ICD
  • 10 guidelines, M84
  • 659 should be used when a pathological fracture occurs in the hip due to an unspecified underlying disease
  • Coders must ensure that the documentation supports the diagnosis and that the fracture is not due to trauma or other specified conditions

Exclusion Criteria

Do NOT use M84.659 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 for patients with hip joint issues related to fractures.

Documentation Requirements

Document the reason for the procedure and any imaging performed.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is linked to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding, which can improve patient care and billing accuracy. M84.659 provides a clear framework for coding pathological fractures due to unspecified diseases, but it requires careful documentation to avoid ambiguity.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding, which can improve patient care and billing accuracy. M84.659 provides a clear framework for coding pathological fractures due to unspecified diseases, but it requires careful documentation to avoid ambiguity.

Reimbursement & Billing Impact

billing accuracy. M84.659 provides a clear framework for coding pathological fractures due to unspecified diseases, but it requires careful documentation to avoid ambiguity.

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