2025 ICD-10-CM code M84.4
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Musculoskeletal - Osteopathies and chondropathies Diseases of the musculoskeletal system and connective tissue (M00-M99) Feed
Pathological fracture, not elsewhere classified.
Modifiers may be applicable depending on the circumstances of the encounter, such as the place of service or the type of provider. Consult local coding guidelines for specific modifier use.
Medical necessity is established by the presence of a pathologic fracture resulting from a pre-existing condition that weakens the bone, requiring intervention for pain management, fracture stabilization, and management of the underlying disease. The severity of the fracture and the impact on the patient's function justify medical intervention.
Diagnosis involves patient history, physical exam, range of motion/muscle strength assessment, imaging (X-ray, MRI, CT, DXA), blood tests (bone and inflammatory markers), and potentially bone biopsy. Treatment may include physical therapy, bracing/casting/splinting, analgesics, nutritional supplements, treatment of underlying disease, and surgery.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- M80-M94 (Osteopathies and chondropathies)
In simple words: A pathological fracture is a broken bone caused by a disease that weakens the bone, not by an injury.The bone breaks easily because it's already weak from a condition like osteoporosis, cancer, or infection.
A pathological fracture is a bone fracture that occurs in a bone weakened by a pre-existing disease process, such as a tumor, infection (osteomyelitis), osteoporosis, or inherited bone disorders.It occurs with minimal or no trauma, unlike a traumatic fracture. This code applies to pathological fractures not otherwise specified or categorized elsewhere.
Example 1: A 70-year-old female with osteoporosis experiences a vertebral fracture after a minor fall, requiring pain management and bracing., A 55-year-old male with bone metastases from prostate cancer develops a pathologic fracture of the femur, necessitating surgery and radiation therapy., A 30-year-old with Paget's disease experiences a spontaneous fracture of the tibia, requiring surgical intervention and bisphosphonate therapy.
Detailed patient history including trauma details (if any), imaging reports (X-ray, CT, MRI, DXA), lab results (bone markers, inflammatory markers), pathology reports (if biopsy performed), treatment plan, and progress notes.
** This code should be used when a pathological fracture is not otherwise specified in more specific codes.Always code the underlying cause in addition to M84.4.
- Payment Status: Active
- Specialties:Orthopedics, Oncology, Rheumatology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Ambulatory Surgical Center