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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.671

M84.671

Billable

Pathological fracture in other disease, right ankle

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

Code Description

ICD-10 M84.671 is a billable code used to indicate a diagnosis of pathological fracture in other disease, right ankle.

Key Diagnostic Point:

A pathological fracture in the right ankle occurs when the bone breaks due to an underlying disease process rather than from a traumatic injury. This type of fracture is often associated with conditions that affect bone density and metabolism, such as osteoporosis, osteogenesis imperfecta, or metastatic bone disease. In patients with osteoporosis, for instance, the bones become porous and brittle, leading to an increased risk of fractures even with minimal or no trauma. The right ankle, being a weight-bearing joint, is particularly susceptible to such fractures. Diagnosis typically involves imaging studies such as X-rays or MRIs to confirm the fracture and assess the underlying bone condition. Treatment may include immobilization, pain management, and addressing the underlying disease to improve bone health. Understanding the etiology of the fracture is crucial for effective management and prevention of future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying diseases affecting bone health.
  • Differentiation from traumatic fractures.
  • Need for comprehensive documentation of the underlying condition.
  • Potential for multiple comorbidities affecting coding.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the location of the fracture.
  • Misclassification as a traumatic fracture.
  • Lack of supporting imaging studies in the medical record.

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 that the underlying disease is well-documented to support the diagnosis.

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

Documentation of bone density tests and treatment plans for underlying conditions.

Coding Guidelines

Inclusion Criteria

Use M84.671 When
  • According to ICD
  • 10 coding guidelines, M84
  • 671 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 not due to trauma
  • It is important to follow the guidelines for coding pathological fractures and to use additional codes for the underlying disease as necessary

Exclusion Criteria

Do NOT use M84.671 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73630CPT Code

Radiologic examination, ankle, two views

Clinical Scenario

Used to confirm the presence of a fracture in the right ankle.

Documentation Requirements

Radiology report must be included in the medical record.

Specialty Considerations

Orthopedic specialists should ensure imaging correlates with clinical findings.

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. M84.671 provides a clear distinction between traumatic and pathological fractures, which is essential for appropriate treatment and reimbursement.

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. M84.671 provides a clear distinction between traumatic and pathological fractures, which is essential for appropriate treatment 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 due to an underlying disease that weakens the bone, while a traumatic fracture results from an external force or injury.