2025 ICD-10-CM code M84
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Musculoskeletal - Osteopathies and chondropathies (M80-M94) Diseases of the musculoskeletal system and connective tissue (M00-M99) Feed
Disorder of bone continuity (fracture) not caused by trauma.
Modifiers may be applicable depending on the circumstances of the fracture care and the specific procedures performed (e.g., anesthesia, surgical approach). Check local payer guidelines and the official CPT modifier guidelines.
Medical necessity is established by the presence of a fracture requiring treatment, whether conservative or surgical.Underlying conditions (like osteoporosis) may also require additional documentation of medical necessity for treatment.
Diagnosis and treatment of bone fractures, including patient history, physical examination, ordering and interpretation of imaging studies, and determination of appropriate treatment plan (conservative or surgical).
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- Osteopathies and chondropathies (M80-M94)
In simple words: This code describes a broken bone that wasn't caused by an accident or injury. It could be from things like playing a rough sport, doing the same motion over and over, or because of another health problem.Doctors will check you over, take X-rays or other scans, and may suggest treatments such as physical therapy, a cast or splint, pain relievers, or even surgery.
A disorder of bone continuity, commonly known as a fracture, refers to a break in a bone.This code specifically excludes fractures resulting from traumatic injury.Causes may include high-impact sports, repetitive movements, or underlying diseases.Clinical presentation includes pain, swelling, deformity, weakness, restricted motion, bruising, and potentially numbness or paralysis if nerve damage is present. Diagnosis involves patient history, physical examination, range of motion and muscle strength assessments, imaging (X-ray, MRI, CT, DXA), and blood tests for bone and inflammatory markers. Treatment options range from physical therapy and immobilization (brace, cast, splint) to medication (analgesics, supplements), treatment of underlying conditions, and surgery.
Example 1: A 50-year-old female marathon runner presents with increasing pain in her left tibia after months of intense training. Imaging reveals a stress fracture.M84 is used to code the fracture, and an additional code is used to specify the location (tibia)., A 70-year-old male with osteoporosis experiences a spontaneous fracture of his right humerus while performing a simple task.M84 is coded to denote the fracture, and additional codes are included for osteoporosis and the location (humerus)., A 25-year-old male weightlifter develops a pathological fracture of his fifth metacarpal due to an underlying bone tumor. M84 is assigned for the fracture; additional codes specify the tumor type and location.
Patient history including mechanism of injury (if any), pain description, relevant medical history (e.g., osteoporosis, bone disease), physical examination findings (swelling, deformity, tenderness, range of motion), imaging reports (X-ray, CT, MRI, DXA), laboratory results (bone markers, inflammatory markers), treatment plan, and progress notes.
** M84 is a broad category and requires additional codes for precise specification of fracture location, type (e.g., stress fracture, pathological fracture), and any associated injuries or complications. Always reference the most current ICD-10-CM guidelines for accurate coding.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Orthopedics, Rheumatology, Internal Medicine, Oncology (for pathological fractures)
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital, Ambulatory Surgical Center