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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.674

M84.674

Billable

Pathological fracture in other disease, right foot

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

Code Description

ICD-10 M84.674 is a billable code used to indicate a diagnosis of pathological fracture in other disease, right foot.

Key Diagnostic Point:

A pathological fracture in the right foot occurs when a bone breaks due to an underlying disease process rather than from an acute injury. This type of fracture is often associated with conditions that weaken bone density, such as osteoporosis, osteogenesis imperfecta, or metastatic cancer. In patients with osteoporosis, the bones become porous and brittle, making them more susceptible to fractures even with minimal trauma. The right foot is a common site for such fractures due to its weight-bearing function and the stress it endures during daily activities. Diagnosis typically involves imaging studies, such as X-rays or MRIs, to confirm the fracture and assess the underlying bone condition. Treatment may include pain management, immobilization, 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 density.
  • 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 exact location of the fracture.
  • Misclassification as a traumatic fracture.
  • Lack of follow-up documentation on treatment and outcomes.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, treatment plans, and follow-up notes.

Common Clinical Scenarios

Patients presenting with fractures after minimal trauma, often with a history of osteoporosis.

Billing Considerations

Ensure that the underlying condition is clearly documented to support the diagnosis of a pathological fracture.

Endocrinology

Documentation Requirements

Bone density test results, treatment for osteoporosis, and management of metabolic bone diseases.

Common Clinical Scenarios

Patients with osteoporosis or other metabolic bone disorders experiencing fractures.

Billing Considerations

Documentation should include details on the management of the underlying condition to justify the pathological fracture diagnosis.

Coding Guidelines

Inclusion Criteria

Use M84.674 When
  • According to ICD
  • 10 coding guidelines, M84
  • 674 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
  • It is important to follow the guidelines for specificity and to include any relevant additional codes for the underlying disease

Exclusion Criteria

Do NOT use M84.674 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 history.

Specialty Considerations

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

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. M84.674 provides a clear distinction between traumatic and pathological fractures, which is essential for accurate 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. M84.674 provides a clear distinction between traumatic and pathological fractures, which is essential for accurate 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. Proper documentation is essential to differentiate between the two for accurate coding.