2025 ICD-10-CM code M84.531P
(Active) Effective Date: N/A Diseases of the musculoskeletal system and connective tissue - Disorders of bone density and structure M00-M99 Feed
Pathological fracture in neoplastic disease of the right ulna, subsequent encounter for fracture with malunion.
Medical necessity is established by the presence of a pathological fracture related to a neoplastic disease, impacting the patient's function and requiring medical intervention for pain management and fracture care.
The provider is responsible for diagnosing the pathological fracture through physical examination, imaging (X-ray, MRI, CT, PET, bone scan), and potentially biopsy. Treatment focuses on pain management, fracture stabilization (e.g., casting), addressing the underlying neoplasm, possible surgery, physical therapy, and lifestyle adjustments.
In simple words: This code indicates a break in the right forearm bone (ulna), not due to an injury, but because of a tumor weakening the bone.This visit shows the bone has not healed properly.
This code describes a non-traumatic fracture of the right ulna due to weakening by a neoplasm (tumor), where the subsequent encounter shows the fracture has healed in a faulty position (malunion).It is for use in cases where the fracture is not directly caused by trauma but rather by the underlying neoplastic disease.
Example 1: A patient with a known bone tumor in their right ulna experiences sudden pain and limited mobility. Imaging reveals a fracture, and during a follow-up visit, it is determined that the fracture has healed with malunion., A patient undergoing cancer treatment develops a spontaneous fracture in their right ulna.After initial treatment, a follow-up shows the bone has healed incorrectly., A patient with a history of a benign bone tumor in their right ulna presents with pain and deformity.Examination and imaging confirm a pathological fracture, and subsequent visits reveal malunion.
Documentation should include the patient's history of neoplastic disease, evidence of the fracture (imaging reports), details of the malunion, treatment provided, and progress notes from subsequent encounters.
- Specialties:Oncology, Orthopedic Surgery, Radiology, Pathology, Physical Therapy
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Office, Outpatient, or other applicable place of service.