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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.661

M84.661

Billable

Pathological fracture in other disease, right tibia

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

Code Description

ICD-10 M84.661 is a billable code used to indicate a diagnosis of pathological fracture in other disease, right tibia.

Key Diagnostic Point:

A pathological fracture refers to a bone fracture that occurs in a bone weakened by an underlying disease process, rather than from a traumatic injury. In the case of M84.661, the fracture is specifically located in the right tibia. Common underlying conditions that can lead to such fractures include osteoporosis, metastatic cancer, osteogenesis imperfecta, and other metabolic bone diseases. Osteoporosis, characterized by reduced bone density and deterioration of bone tissue, is a significant contributor to pathological fractures, particularly in older adults. The right tibia, being a weight-bearing bone, is susceptible to fractures under conditions of compromised bone integrity. Diagnosis typically involves imaging studies such as X-rays or CT scans to confirm the fracture and assess the extent of bone involvement. Management may include pain control, stabilization of the fracture, and treatment of the underlying disease to improve bone health and prevent future fractures. Understanding the etiology of the fracture is crucial for effective treatment and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying diseases affecting bone health.
  • Differentiation from traumatic fractures.
  • Documentation of the underlying condition is essential.
  • Potential for multiple co-morbidities affecting coding.

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 documentation.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with fractures due to osteoporosis or metastatic disease.

Billing Considerations

Ensure imaging studies are documented to support the diagnosis.

Endocrinology

Documentation Requirements

Documentation of metabolic bone diseases and treatment plans.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic disorders leading to fractures.

Billing Considerations

Linking bone density studies to fracture occurrences is crucial.

Coding Guidelines

Inclusion Criteria

Use M84.661 When
  • According to ICD
  • 10 guidelines, M84
  • 661 should be used when a fracture occurs in the context of an underlying disease
  • Coders must ensure that the underlying condition is documented and that the fracture is confirmed through imaging
  • It is important to follow the guidelines for specificity in coding anatomical locations

Exclusion Criteria

Do NOT use M84.661 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 joint aspiration is needed due to fracture complications.

Documentation Requirements

Document the reason for aspiration and findings.

Specialty Considerations

Orthopedic specialists often perform this procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding fractures, including the ability to capture the underlying disease processes that contribute to pathological fractures. This has improved data accuracy and has implications for treatment planning and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, including the ability to capture the underlying disease processes that contribute to pathological fractures. This has improved data accuracy and has implications for treatment planning and reimbursement.

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.