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2025 ICD-10-CM code M84.47

Pathological fracture of the ankle, foot, and toes due to underlying disease.

Appropriate use of seventh character (A, D, G, K, P, S) to indicate encounter type is necessary.Additional codes should be used to specify the underlying disease that led to the pathological fracture.

Modifiers may be applicable depending on the circumstances of the encounter and the services rendered (e.g., laterality modifiers).

Medical necessity is established when a pathological fracture is documented, along with the underlying condition causing bone weakening and the need for treatment.Justification should include the clinical findings, imaging evidence, and the impact of the fracture on the patient’s function.

Diagnosis involves patient history, physical exam, imaging (X-rays, MRI, CT, DXA), blood tests, and possibly bone biopsy. Treatment includes pain management, immobilization, addressing the underlying disease, and potentially surgery.

IMPORTANT:Consider additional codes to specify the underlying disease causing the fracture (e.g., codes from M80-M85 for osteoporosis, C00-D49 for neoplasms, A00-B99 for infections).

In simple words: This code means a broken bone in the ankle, foot, or toes caused by an illness like osteoporosis, cancer, or infection, not by an accident or injury. Doctors use X-rays and other tests to diagnose it. Treatment might involve pain relievers, a cast or brace, and treating the underlying illness.

M84.47, in the ICD-10-CM classification, denotes a pathological fracture affecting the ankle, foot, or toes.This signifies a bone fracture resulting from a pre-existing disease process rather than trauma.The underlying condition could encompass various diseases like osteoporosis, tumors, infections, or inherited bone disorders.The diagnosis relies on patient history, physical examination, imaging studies (X-rays, MRI, CT scans, DXA), blood tests for bone and inflammatory markers, and potentially a bone biopsy. Treatment may involve analgesics, immobilization (bracing, splinting, casting), nutritional supplementation, physical therapy, addressing the underlying disease, and potentially surgery.

Example 1: A 70-year-old woman with osteoporosis experiences a fracture of her left ankle while stepping out of a car.The fracture is caused by weakened bone structure due to osteoporosis., A 55-year-old man with bone cancer develops a pathological fracture in his foot due to weakening of the bone by the tumor., A 30-year-old woman with a history of inherited bone disease experiences a spontaneous fracture of a toe due to the fragility of the bone.

Detailed patient history, physical examination findings, imaging reports (X-rays, MRI, CT, DXA), laboratory results (blood tests, bone markers, inflammatory markers), biopsy reports (if performed), and treatment plan documentation.

** This code should be used only when the fracture is a direct result of a pre-existing disease and not due to trauma.The underlying disease should be documented using an additional code.Consider using appropriate laterality modifiers as needed.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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iFrame™ AI's knowledge is aligned with and limited to the materials uploaded by users and should not be interpreted as medical, legal, or any other form of advice by iFrame™.