2025 ICD-10-CM code M84.5
Pathological fracture in neoplastic disease. Code also underlying neoplasm.
Seventh character is required to indicate encounter type and healing stage.
Medical necessity is established by the presence of a fracture in a bone weakened by a neoplastic disease. Documentation should support the causal link between the neoplasm and the fracture. The medical record should demonstrate the impact of the fracture on the patient's function and mobility, justifying the need for intervention.
Physicians diagnose pathological fractures based on medical history, physical examination, and imaging studies (X-ray, CT, MRI, PET, bone scan), often supplemented by blood tests and biopsies. Treatment focuses on pain management (analgesics), fracture stabilization (casting), treating the underlying neoplasm (chemotherapy, radiation, surgery), and rehabilitation (physical therapy).
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- M84.5 is a subcategory of M84 (Disorder of continuity of bone) and belongs to the larger category of M80-M94 (Osteopathies and chondropathies) and chapter M00-M99 (Diseases of the musculoskeletal system and connective tissue).
In simple words: A broken bone caused by a tumor, either benign or cancerous, that has weakened the bone. It's important to also code for the tumor itself.
A fracture occurring in a bone weakened by a neoplastic process, whether benign or malignant.This code should be used in addition to the code for the underlying neoplasm.
Example 1: A patient with a known history of metastatic breast cancer presents with sudden onset of thigh pain after standing up.An x-ray reveals a femoral fracture.The code M84.5 would be used along with the code for the metastatic breast cancer., A patient with multiple myeloma experiences back pain. Imaging reveals a vertebral compression fracture. The code M84.5 would be used in conjunction with the code for multiple myeloma., A child with Ewing's sarcoma of the humerus falls and sustains a fracture at the site of the tumor. Code M84.5 is used with the code for Ewing's sarcoma.
Documentation should clearly indicate the presence of a fracture, the location of the fracture, and the underlying neoplastic disease. The type, location, and laterality of the fracture must be specified. Evidence of the neoplasm through imaging, biopsy, or other diagnostic reports should be included. Details of the incident/fall, if any, should also be documented. If there is osteoporosis present, documentation should indicate that as well.
- Specialties:Oncology, Orthopedic Surgery, Radiology, Pathology
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Office, Emergency Room - Hospital, and other places where fracture care is provided.