2025 ICD-10-CM code M84.561D
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the musculoskeletal system and connective tissue - Osteopathies and chondropathies Chapter 13: Diseases of the musculoskeletal system and connective tissue Feed
Pathological fracture in neoplastic disease of the right tibia, subsequent encounter with routine healing.
Medical necessity is established by the presence of a pathological fracture requiring medical or surgical management. Documentation must support the diagnosis and demonstrate the need for treatment.
Diagnosis involves patient history, physical examination (range of motion), imaging (X-rays, MRI, CT, PET, bone scan), blood tests for neoplasm, and potentially a bone biopsy. Treatment may include analgesics, casting, physical therapy, treatment of the underlying neoplasm, and/or surgical fracture repair.
- Chapter 13: Diseases of the musculoskeletal system and connective tissue
- M80-M94 (Osteopathies and chondropathies)
In simple words: This code is for a follow-up doctor's visit after a broken bone in the right shin caused by cancer. The bone is healing normally.
This code signifies a subsequent encounter for a pathological fracture (fracture caused by a benign or malignant neoplasm, not trauma) in the right tibia.The fracture is healing normally.This code is used for follow-up visits where the healing process is progressing as expected.
Example 1: A 65-year-old patient with a known history of osteosarcoma in the right tibia presents for a follow-up appointment.Imaging shows the fracture is healing without complications., A 72-year-old patient with metastatic breast cancer experiences a spontaneous fracture of the right tibia. After initial fracture management, the patient returns for a follow-up visit showing uneventful healing., A 58-year-old patient with multiple myeloma develops a pathological fracture in the right tibia. After surgical fixation, the patient undergoes rehabilitation and presents for a routine follow-up visit indicating appropriate healing progress.
Medical record should include documentation of the underlying neoplasm, imaging studies demonstrating the fracture and the healing process, details of any treatment provided (e.g., surgery, casting, medication), and progress notes at each follow-up visit.
** Always code the underlying neoplasm in addition to this code.Appropriate external cause codes may also be needed depending on the circumstances.
- Payment Status: Active
- Specialties:Oncology, Orthopedic Surgery
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient