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2025 ICD-10-CM code M84.563P

Pathological fracture in neoplastic disease of the right fibula, subsequent encounter for fracture with malunion.

Use an external cause code (e.g., from Chapter XX) following the code for the musculoskeletal condition if applicable, to identify the cause of the underlying neoplasm.

Medical necessity is established by the presence of a pathological fracture in the right fibula due to a neoplasm, and the need for ongoing care for the resultant malunion. The documentation should clearly link the fracture to the neoplasm and justify the continued treatment.

Diagnosis is based on patient history, physical exam (including range of motion), imaging (X-ray, MRI, CT, PET, bone scan), lab tests (for neoplasm), and possibly biopsy. Treatment may involve pain management, casting, physical therapy, treatment of the underlying neoplasm, and/or surgery.

In simple words: This code indicates a broken right fibula bone due to a tumor, not an injury.It's used for follow-up visits when the bone has not healed properly.

This code describes a fracture of the right fibula due to an underlying neoplasm (tumor), not trauma. It is used for subsequent encounters after the initial fracture diagnosis when the bone has healed with malunion (in a faulty position or incompletely).

Example 1: A patient with a known bone tumor in their right fibula experiences a sudden pain and is found to have a fracture through the tumor site. After initial treatment, follow-up visits for the malunion are coded with M84.563P., A patient undergoing treatment for a cancerous tumor in their right fibula develops a pathological fracture. The fracture heals in a slightly bent position. Subsequent encounters for this malunion are coded M84.563P., A patient with a history of a benign bone tumor in the right fibula sustains a pathological fracture.During the healing process, the bone doesn't fully knit together, resulting in an incomplete union. Follow-up appointments related to this incomplete union are coded as M84.563P.

Documentation should include evidence of the underlying neoplasm, the presence of the fracture, the type of malunion (e.g., angulation, shortening, displacement), and the treatment provided.

** This code is only for subsequent encounters related to the malunion. The underlying neoplasm should also be coded. This code should not be used for traumatic fractures.

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