2025 ICD-10-CM code M84.68
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Osteopathies and chondropathies - Disorders of bone density and structure Diseases of the musculoskeletal system and connective tissue (M00-M99) Feed
Pathological fracture in other disease, other site.
Modifiers may be applicable depending on the circumstances of the encounter and services provided.Consult official coding guidelines for appropriate modifier use.
Medical necessity is established by the presence of a pathological fracture requiring intervention to alleviate pain, restore function, prevent further complications, or address the underlying disease process.This would generally include evidence of bone weakness from underlying disease and the need for medical or surgical treatment.
Diagnosis involves patient history, physical examination (range of motion, muscle strength), imaging (X-rays, MRI, CT, DXA), and blood tests (ESR). Treatment may include analgesics, bracing/splinting, nutritional supplements (calcium), lifestyle changes, physical therapy, treatment of the underlying condition, or surgery.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- M80-M94 (Osteopathies and chondropathies)
In simple words: This code describes a broken bone caused by a disease that made the bone weak.It's important to note that this code doesn't describe the disease that caused the break, only the broken bone itself.
This ICD-10-CM code signifies a pathological fracture (a fracture caused by a disease process weakening the bone) occurring at a site other than those specified elsewhere in the ICD-10-CM classification.The underlying disease causing the bone weakening is not the focus of this code; rather, the fracture itself is the primary concern.Additional codes are required to specify the location of the fracture and the underlying disease.
Example 1: A 70-year-old woman with metastatic breast cancer experiences a spontaneous fracture of her right humerus. The focus of treatment is the fracture management and pain control.Code M84.68XD would be used to describe the subsequent encounter for the fracture with delayed union, along with a code for the metastatic breast cancer and any relevant external cause codes., A 55-year-old male with Paget's disease experiences a fracture of his left femur after a minor fall. The fracture is determined to be pathological due to bone weakening from Paget's disease.Code M84.68XA would be assigned for the initial encounter of the fracture, along with a code for Paget's disease., A 60-year-old female with osteoporosis presents with a spontaneous fracture of the vertebral body.The focus is on fracture management, and the osteoporosis is a contributing factor. Code M80.0 (Osteoporosis with current pathological fracture of unspecified site) would be the more appropriate primary diagnosis since the fracture is related to osteoporosis.M84.68 is not used in this case.
Detailed patient history, physical examination findings (including location, mechanism of injury, and assessment of pain, swelling, and deformity), imaging reports (X-rays, CT, MRI, DXA scans), laboratory results (e.g., ESR), and treatment plan documentation (medications, bracing, surgery, etc.).Documentation should also include details about the underlying disease process that caused the pathological fracture.
** Always code the underlying condition along with M84.68.Use of this code requires careful consideration of the primary focus of treatment (the fracture or the underlying disease).Refer to the official ICD-10-CM coding manual for specific guidelines and examples.
- Payment Status: Active
- Specialties:Orthopedics, Oncology, Rheumatology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office