2025 ICD-10-CM code M84.58
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Musculoskeletal System - Osteopathies and chondropathies Diseases of the musculoskeletal system and connective tissue (M00-M99) Feed
Pathological fracture in neoplastic disease of other specified site.
Modifiers may be used to indicate the location of the fracture (e.g., laterality), the type of procedure, and other relevant circumstances. Consult the specific payer guidelines for appropriate modifier usage.
Medical necessity is established by demonstrating a pathological fracture resulting from a pre-existing neoplasm, necessitating medical intervention such as pain management, fracture stabilization, or treatment of the underlying condition.Justification should include clinical findings supporting the diagnosis and the rationale for the selected treatment approach.
The clinical responsibility involves diagnosing the pathological fracture (through history, physical examination, and imaging), determining the underlying neoplasm, and coordinating treatment that might include pain management, fracture stabilization, and treatment of the cancer.This often requires collaboration between orthopedics, oncology, and potentially other specialties.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- Osteopathies and chondropathies (M80-M94); Disorders of bone density and structure (M80-M85)
In simple words: A broken bone caused by a tumor in a specific part of the body. The bone breaks easily because the tumor weakens it. Doctors use X-rays and other scans to diagnose this condition. Treatment involves pain relief, possibly surgery to repair the break, and treatment of the tumor.
This code signifies a fracture occurring in a bone weakened by a benign or malignant neoplasm (tumor) at a site other than those specifically listed elsewhere in the ICD-10-CM classification.The fracture results from minimal or no trauma, unlike a traumatic fracture.The diagnosis is established through patient history, physical examination (assessing range of motion), imaging studies (X-rays, MRI, CT, PET scans, bone scans), blood tests to detect neoplasms, and potentially a bone biopsy.Treatment may encompass pain management (analgesics), fracture stabilization (casting), physical therapy, treatment of the underlying neoplasm, and/or surgical intervention.
Example 1: A 70-year-old female with a history of breast cancer presents with sudden onset of severe back pain.Imaging reveals a compression fracture of a vertebra due to metastatic disease. The code M84.58 is used, along with codes specifying the location (vertebral fracture) and the type of cancer (breast cancer)., A 65-year-old male with multiple myeloma experiences a spontaneous fracture of the femur.Imaging confirms the fracture.M84.58 is used with codes for the femur fracture location and the underlying multiple myeloma diagnosis., A 50-year-old female with lung cancer develops a pathological fracture of the humerus after a minor fall.The fracture is surgically repaired.The code M84.58 is used, along with codes for the fracture location, the type of surgery, and the underlying lung cancer.
Complete patient history, physical examination findings, imaging reports (X-rays, CT, MRI, bone scan), laboratory results (blood tests to detect the neoplasm), pathology reports (if biopsy was performed), operative reports (if surgery was done), and details about the treatment plan.
** Always code the underlying neoplasm.Additional codes are required to specify the location and type of fracture, and any further procedures undertaken.
- Revenue Code: Revenue codes will vary depending on the specific services provided (e.g., imaging, surgery, consultation).
- RVU: RVUs will vary significantly based on the complexity of the case, the location and severity of the fracture, the type of intervention (e.g., non-operative management versus surgical intervention), and the geographic location of the practice. Consult appropriate fee schedules and local payer guidelines.
- Global Days: The global period will depend on the type of surgical procedure performed, if any.Check with the specific payer or the facility's billing guidelines for the correct global period.
- Payment Status: Active (Payment depends on payer and other factors)
- Modifier TC rule: The use of a technical component (TC) modifier would depend on the specific services rendered, especially if there is a surgical procedure involved. Consult the payer guidelines for TC modifier usage.
- Fee Schedule: Historical fee schedule data is not available within this context.Consult appropriate fee schedules and local payer guidelines.
- Specialties:Orthopedics, Oncology, Hematology/Oncology, Radiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Ambulatory Surgical Center