2025 ICD-10-CM code M84.6
(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 in other disease.
Modifiers may be applicable depending on the circumstances of the encounter and the procedures performed.
Medical necessity for treatment of a pathological fracture is established by the presence of a fracture in a bone weakened by a pre-existing condition, leading to pain, disability, or risk of further complications.The necessity for specific treatments (e.g., surgery) is determined by individual clinical findings.
Diagnosis and treatment of pathological fractures involve a multidisciplinary approach. Orthopedic surgeons often manage the fracture itself, while other specialists (oncologists, infectious disease specialists, endocrinologists) address the underlying disease.Imaging specialists (radiologists) are involved in diagnosis.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- M80-M94 (Osteopathies and chondropathies)
In simple words: This code describes a broken bone caused by a disease that weakened the bone, not by an injury.The disease could be an infection, cancer, or another bone problem.It often causes pain and swelling, and sometimes needs surgery to fix.
A pathological fracture is a fracture occurring in a bone weakened by a pre-existing disease process, such as an infection, tumor, or metabolic bone disorder, rather than by trauma.It often presents with pain, swelling, deformity, and potential neurological complications depending on the location and severity. Diagnosis involves patient history, physical examination, and imaging studies (X-rays, MRI, CT, DEXA) to assess bone density and identify the underlying cause. Treatment strategies include pain management, immobilization (bracing, splinting), addressing the underlying disease, nutritional support, physical therapy, and possibly surgical intervention.
Example 1: A 70-year-old woman with osteoporosis experiences a vertebral compression fracture after minimal trauma (coughing).The fracture is classified as M84.6 due to the underlying osteoporosis., A 55-year-old man with metastatic bone cancer from prostate cancer presents with a pathologic fracture of the femur.M84.6 is used, along with codes for the cancer and its metastasis., A 30-year-old woman with Paget's disease of bone sustains a fracture of the tibia during a low-impact fall.The fracture is coded as M84.6, with additional codes specifying Paget's disease and fracture location.
Detailed patient history, including any trauma, previous bone issues, and relevant medical history.Imaging reports (X-rays, CT, MRI, DEXA scan) are crucial for diagnosis and determining the underlying condition.Laboratory test results, including bone markers and other relevant blood tests, should be included.Treatment plan, including any surgical procedures or medication, should also be documented.
** Always code the underlying disease causing the bone weakness.If the underlying disease is unknown, code M84.4 instead of M84.6.
- Payment Status: Active
- Modifier TC rule: Depending on the circumstances of the procedure and the provider's role, technical component modifiers might be used.Refer to the relevant guidelines.
- Specialties:Orthopedics, Oncology, Rheumatology, Endocrinology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Ambulatory Surgical Center