2025 ICD-10-CM code M84.561P
Pathological fracture in neoplastic disease of the right tibia, subsequent encounter for fracture with malunion.
Medical necessity is established by the presence of a pathological fracture in the right tibia caused by a neoplastic disease, and the need for ongoing care due to malunion. The documentation should clearly link the fracture to the underlying neoplasm and demonstrate the functional limitations resulting from the malunion, justifying the need for continued medical intervention.
The provider diagnoses the condition based on patient history, physical examination (including range of motion assessment), imaging studies (X-rays, MRI, CT, PET, bone scan), laboratory tests (blood work for neoplasm markers), and possibly a bone biopsy. Treatment involves pain management with analgesics, fracture stabilization with a cast, physical therapy for range of motion, muscle strengthening, and flexibility, and treatment of the underlying neoplasm. Surgical intervention for the fracture may also be necessary.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- M84.5 - Pathological fracture in neoplastic diseaseM84 - Pathological fracture, not elsewhere classifiedM80-M94 - Osteopathies and chondropathiesM00-M99 - Diseases of the musculoskeletal system and connective tissue
In simple words: This code refers to a broken right shinbone caused by a tumor, and this visit is for follow-up care where the bone has not healed properly.
This code describes a pathological fracture of the right tibia due to a neoplastic disease. It is used for subsequent encounters where the fracture has healed with malunion (incomplete union or union in a faulty position).
Example 1: A patient with a history of bone cancer in their right tibia experiences a sudden fracture after minimal trauma. After initial treatment, follow-up visits reveal that the fracture has healed in a malaligned position., A patient undergoing treatment for a malignant tumor in the right tibia presents with pain and swelling. Imaging reveals a pathological fracture. Subsequent visits show the bone healing with incomplete union. , A patient with a benign bone tumor in the right tibia experiences a fracture. Follow-up appointments reveal that the fracture has united, but in an abnormal alignment, causing functional impairment.
Documentation should include the patient's history of neoplastic disease, details of the fracture event, imaging reports confirming the fracture and its location in the right tibia, evidence of malunion (e.g., from physical exam or imaging), treatment provided (pain management, casting, physical therapy, surgery), and progress notes.
- Payment Status: Active
- Specialties:Orthopedic Oncology, Oncology, Radiology
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Skilled Nursing Facility