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2025 ICD-10-CM code M84.561G

Pathological fracture in neoplastic disease of the right tibia, subsequent encounter for fracture with delayed healing.

An external cause code should be used if applicable, to identify the cause of the fracture, such as a fall.

Medical necessity is established by the presence of a pathological fracture in the right tibia due to a neoplastic disease, with documented delayed healing requiring ongoing care.

Diagnosis involves patient history, physical exam, imaging (X-ray, MRI, CT, PET, bone scan), lab tests (blood, biopsy). Treatment includes pain management, casting, physical therapy, treating the underlying neoplasm, and potentially surgery.

In simple words: This code indicates a broken right shinbone due to a tumor, and the bone is healing slower than expected.

This code describes a fracture of the right tibia due to an underlying neoplasm (tumor), rather than trauma. It is used for a subsequent encounter where the healing process is delayed.

Example 1: A patient with a known bone tumor in their right tibia experiences a fracture at the site of the tumor. They are seen for a follow-up appointment where imaging shows the fracture is healing slowly., A patient undergoing treatment for bone cancer in their right tibia presents with pain and swelling. Imaging reveals a new pathological fracture, and subsequent visits indicate delayed healing., A patient with a history of a benign bone tumor in their right tibia sustains a minor fall. Imaging reveals a fracture at the site of the tumor, and follow-up appointments show slow healing due to the underlying condition.

Documentation should include evidence of the underlying neoplasm, the location and type of fracture, the delayed healing status (e.g., imaging reports, clinical findings), and details of all treatments provided.

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