2025 ICD-10-CM code M84.561K
Pathological fracture in neoplastic disease, right tibia, subsequent encounter for fracture with nonunion.
Medical necessity is established by the presence of a pathological fracture due to a neoplasm in the right tibia, with nonunion confirmed by imaging. The documentation should clearly demonstrate the need for ongoing care and the specific treatment plan.
Diagnosis is based on patient history, physical examination (range of motion), imaging (X-ray, MRI, CT, PET, bone scan), lab tests (blood, biopsy). Treatment includes pain management, casting, physical therapy, treating the underlying neoplasm, and possibly surgery.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- M84.561: Pathological fracture in neoplastic disease, right tibiaM84.5: Pathological fracture in neoplastic disease, right tibiaM84: Pathological fracture in neoplastic disease
In simple words: A broken right shin bone due to a tumor or cancer, that hasn't healed properly after a previous visit.
Pathological fracture in neoplastic disease of the right tibia refers to a fracture (broken bone) due to benign or malignant neoplasm rather than from trauma. This code applies to subsequent encounters for nonunion of fracture, the failure of a bone to grow back together following a break.
Example 1: A patient with a history of bone cancer in their right tibia presents with persistent pain and instability several weeks after a fall. Imaging confirms a fracture at the site of the previous tumor, with no signs of healing, indicating nonunion., A patient undergoing chemotherapy for a malignant neoplasm in their right tibia experiences sudden pain in their lower leg. Imaging reveals a pathological fracture, and after several months, follow-up imaging shows the bone has not united., A patient with a benign bone tumor in their right tibia suffers a minor injury, leading to a fracture. Despite conservative treatment, the fracture fails to heal after an extended period, indicating nonunion.
Documentation should include evidence of the neoplasm (benign or malignant), the location (right tibia), the type of fracture (pathological), the nonunion status, and the treatment provided. Imaging reports, biopsy results, treatment notes, and patient history should be included.
** This is a subsequent encounter code. For the initial encounter, use M84.561A. Other 7th character options exist for routine healing (D), delayed healing (G), malunion (P), and sequela (S).
- Specialties:Orthopedic Oncology, Oncology, Orthopedics
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Independent Clinic