2025 ICD-10-CM code M84.68XP
(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, other site, subsequent encounter for fracture with malunion.
Modifiers are not applicable to ICD-10 codes.
Medical necessity is established by the presence of a pathological fracture with malunion requiring medical attention.This may include pain management, functional improvement, or prevention of complications.The underlying disease condition also needs to be documented and managed appropriately.
The clinical responsibility involves diagnosing the malunion, assessing the patient's condition, and determining the appropriate course of action, which may include pain management, immobilization, physical therapy, or surgical intervention.This also includes management of the underlying condition that caused the pathological fracture.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- M80-M94 (Osteopathies and chondropathies)
In simple words: This code is used for a follow-up doctor's visit after a broken bone that happened because of a disease that weakened the bone. The broken bone didn't heal correctly.
This ICD-10-CM code signifies a subsequent encounter for a pathological fracture (a fracture caused by a pre-existing disease weakening the bone) at a site other than those specifically listed in other codes, where the fracture has resulted in malunion (an incomplete or improperly aligned bone union).This is a follow-up visit after the initial fracture treatment.
Example 1: A 70-year-old woman with osteoporosis presents for a follow-up visit after a pathological fracture of her humerus. X-rays reveal malunion. The physician assesses her pain, range of motion, and functional status, and determines the need for physical therapy., A 65-year-old man with bone cancer has a pathological fracture of his femur.After surgery to stabilize the fracture, he is seen in follow-up, showing evidence of malunion. The physician discusses options for revision surgery or other interventions., A 50-year-old woman with Paget's disease had a pathological fracture of her tibia six months ago. She returns with continued pain and limited mobility. Imaging reveals malunion. The physician orders further imaging and discusses surgical correction.
* Detailed patient history, including the initial fracture, treatment received, and any relevant medical conditions.* Physical examination findings, documenting pain, swelling, range of motion, and neurovascular status.* Imaging reports (X-rays, CT scans, MRI) demonstrating malunion.* Documentation of the underlying disease process that led to the pathological fracture.* Notes on any prior treatment for the fracture and current treatment plan.
** The "P" suffix indicates a subsequent encounter for a fracture with malunion.Appropriate documentation is crucial for accurate coding and reimbursement.If the malunion is due to a specific complication (e.g., infection), that complication should also be coded.
- Revenue Code: Revenue codes will vary based on the specific services rendered during the encounter (e.g., evaluation and management, imaging, etc.).
- RVU: RVUs are not directly assigned to ICD-10 codes. Reimbursement is determined by the procedures and services performed, which would be coded using CPT codes, and these CPT codes would have associated RVUs.
- Global Days: Not applicable to ICD-10 codes. Global surgical periods apply to procedural codes (CPT codes) only.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.TC modifiers apply to CPT codes for procedures.
- Fee Schedule: Not applicable to ICD-10 codes. Fee schedules apply to CPT and HCPCS codes.
- Specialties:Orthopedics, Oncology, Rheumatology
- Place of Service:Office, Hospital, Outpatient clinic