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2025 ICD-10-CM code M84.550K

Pathological fracture in neoplastic disease of the pelvis, subsequent encounter for fracture with nonunion.

Be sure to also code the underlying neoplasm. An external cause code can be added to indicate the cause of the fracture if applicable (though these are usually non-traumatic).

Medical necessity is established by the presence of a pathological fracture with nonunion, significantly impacting the patient's function and quality of life. Treatment aims to alleviate pain, promote healing, and restore function.

Diagnosis involves patient history, physical exam, imaging (X-ray, MRI, CT, PET, bone scan), lab tests, and possibly biopsy. Treatment includes pain management, casting, addressing the underlying neoplasm, and potential surgery, along with physical therapy and lifestyle counseling.

In simple words: This code is used when a bone in your hip breaks because it's been weakened by a tumor, and it hasn't healed properly after a previous visit.

This code describes a non-traumatic fracture of the pelvis due to a weakened bone structure caused by a tumor (benign or cancerous).It is used for subsequent encounters where the fracture has failed to heal (nonunion).

Example 1: A patient with a history of bone cancer in the pelvis presents with persistent pain and limited mobility months after initial treatment for a pathological fracture. Imaging confirms nonunion of the fracture., A patient undergoing chemotherapy for a pelvic tumor experiences a sudden onset of hip pain after a minor fall. Imaging reveals a pathological fracture. This is the second visit regarding this fracture and nonunion is present., A patient with a benign pelvic tumor experiences a fracture while walking.Following initial treatment, they return for a follow-up appointment where nonunion of the fracture is diagnosed.

Documentation should include evidence of the underlying neoplasm, the pathological fracture, details of the nonunion (e.g., imaging reports), and all treatment provided.

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