2025 ICD-10-CM code M84.68XD
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Musculoskeletal diseases - Osteopathies and chondropathies Chapter 13: Diseases of the musculoskeletal system and connective tissue Feed
Pathological fracture in other disease, other site, subsequent encounter for fracture with routine healing.
Medical necessity is established by the presence of a pathological fracture requiring diagnosis and treatment.The underlying disease contributing to the fracture should be documented to support the medical necessity of the treatment rendered.The necessity of follow-up care for monitoring healing is inherent to fracture management.
The clinical responsibility includes diagnosing the fracture (using patient history, physical exam, imaging studies like X-rays, MRI, CT scans, and bone density tests), managing pain and swelling (medication, bracing, splinting), addressing the underlying disease, and potentially performing surgery for fracture repair.Follow-up care to monitor healing is also crucial.
- Chapter 13: Diseases of the musculoskeletal system and connective tissue
- M80-M94 (Osteopathies and chondropathies)
In simple words: This code is used for a follow-up visit after a broken bone caused by a disease that weakened the bone. The break is healing normally.
This ICD-10-CM code signifies a subsequent encounter for a pathological fracture (a fracture occurring in a bone weakened by a pre-existing disease) at a site other than those specifically listed in the codebook, where the fracture is healing normally.It indicates that the initial fracture has been treated, and the patient is now undergoing routine follow-up care for normal healing.This code excludes pathological fractures related to osteoporosis.
Example 1: A 65-year-old woman with metastatic breast cancer experiences a spontaneous fracture of her humerus.After surgical fixation, she is seen for a follow-up visit to assess healing progress. Code M84.68XD is used., A 70-year-old man with Paget's disease presents with a fracture of his tibia.He undergoes ORIF and is seen in the clinic several weeks later for a progress check.Code M84.68XD is assigned., An 80-year-old patient with osteogenesis imperfecta presents with a spontaneous fracture of the radius. They receive non-surgical management and are seen in follow up for healing progress. Code M84.68XD is used.
* Detailed patient history, including the underlying disease.* Physical examination findings, noting pain, swelling, deformity, and range of motion.* Imaging studies (X-rays, CT scans, MRI) demonstrating the fracture and its healing status.* Laboratory results (if any).* Treatment provided (surgical or non-surgical).* Documentation of follow-up care and healing progress.
** This code is only for subsequent encounters where healing is routine.Other codes exist for initial encounters, delayed healing, nonunion, malunion, and sequelae.
- Payment Status: Active
- Specialties:Orthopedics, Oncology, Rheumatology
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Skilled Nursing Facility