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ICD-10 Guide
ICD-10 CodesM84.669

M84.669

Billable

Pathological fracture in other disease, unspecified tibia and fibula

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

Code Description

ICD-10 M84.669 is a billable code used to indicate a diagnosis of pathological fracture in other disease, unspecified tibia and fibula.

Key Diagnostic Point:

M84.669 refers to a pathological fracture occurring in the tibia and fibula due to underlying diseases that affect bone density and metabolism, such as osteoporosis, osteomalacia, or metastatic bone disease. These fractures are not the result of trauma but rather occur due to weakened bone structure from these conditions. Osteoporosis, characterized by decreased bone mass and deterioration of bone tissue, significantly increases the risk of fractures, particularly in the elderly population. Pathological fractures can occur with minimal or no trauma, often presenting in patients with chronic conditions that compromise bone integrity. The tibia and fibula are common sites for these fractures due to their weight-bearing function. Diagnosis typically involves imaging studies, such as X-rays or CT scans, to confirm the fracture and assess the underlying bone condition. Treatment may include stabilization of the fracture, management of the underlying disease, and rehabilitation to restore function. Accurate coding is essential for proper treatment reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying diseases that can lead to 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 site 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 after minimal trauma, often with a history of osteoporosis.

Billing Considerations

Ensure comprehensive documentation of bone density tests and treatments for underlying conditions.

Endocrinology

Documentation Requirements

Documentation of metabolic bone diseases and treatment plans.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders experiencing fractures.

Billing Considerations

Focus on the management of the underlying disease and its impact on bone health.

Coding Guidelines

Inclusion Criteria

Use M84.669 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the fracture site and the underlying disease
  • Include any relevant imaging studies and treatment plans in the patient's medical record

Exclusion Criteria

Do NOT use M84.669 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 the procedure and the patient's fracture history.

Specialty Considerations

Orthopedic specialists should ensure accurate coding based on the fracture's impact on joint function.

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 ensuring better reimbursement for treatment.

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 ensuring better reimbursement for treatment.

Reimbursement & Billing Impact

reimbursement for treatment.

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.