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2025 ICD-10-CM code M84.473D

Pathological fracture of an unspecified ankle, subsequent encounter for fracture with routine healing.

Do not use this code for initial encounter for a pathological fracture. Do not use this code if the fracture is healing with complications, such as delayed healing, malunion, or nonunion. Use a code from category M84.47- with 7th character G, K, or P for these scenarios, respectively. An external cause code should be added to identify the underlying disease causing the pathological fracture.

Medical necessity is established by the presence of a pathological fracture requiring ongoing management and treatment of the underlying disease. Subsequent encounters are necessary to monitor healing and ensure appropriate treatment is being provided.

Diagnosis and treatment of the underlying condition causing the pathological fracture, as well as management of the fracture itself.This can include pain management, immobilization, physical therapy, and/or surgical intervention.

In simple words: This code is used for a follow-up doctor visit for a broken ankle bone caused by a disease like osteoporosis, not an injury. The doctor hasn't yet specified whether it's the right or left ankle, and the bone is healing as expected.

This code describes a follow-up visit for a pathological fracture of the ankle where the side (right or left) is not specified and the fracture is healing normally.A pathological fracture occurs due to an underlying disease process weakening the bone, rather than direct trauma.

Example 1: A patient with osteoporosis has a follow-up appointment for a previously diagnosed pathological fracture in their ankle. The fracture is healing normally., A patient with bone cancer has a follow-up visit for a pathological ankle fracture. The cancer is being treated, and the fracture is showing signs of routine healing. , A patient with Paget's disease of bone is being monitored for a pathological ankle fracture.This encounter documents the routine healing process.

Documentation should support the diagnosis of a pathological fracture and the underlying condition causing the fracture. Evidence of routine healing should be present, such as X-rays or clinical exam findings. The absence of trauma causing the fracture should also be documented.

  • Specialties:Orthopedics, Oncology, Endocrinology, Internal Medicine
  • Place of Service:Office, Outpatient Hospital, Inpatient Hospital (if further treatment is required)
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