2025 ICD-10-CM code M84.68XS
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Musculoskeletal diseases - Osteopathies and chondropathies Diseases of the musculoskeletal system and connective tissue (M00-M99) Feed
Sequela of a pathological fracture at a site other than those specified elsewhere.
ICD-10-CM codes do not use modifiers.Modifiers are used with CPT and HCPCS codes.
Medical necessity for coding M84.68XS is established by the presence of a documented pathologic fracture related to an underlying disease, with subsequent long-term complications such as pain, limited mobility, or deformity. Appropriate documentation is critical for demonstrating the need for medical care.
The clinical responsibility for a pathological fracture involves diagnosis (history, physical examination, imaging studies like X-rays, MRI, CT, and DEXA scans), determination of the underlying disease, and treatment (medication, bracing, nutritional supplements, physical therapy, or surgery).Different specialists might be involved, depending on the patient’s overall condition and the location of the fracture.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- M80-M94 (Osteopathies and chondropathies)
In simple words: This code is for a broken bone that happened because of a disease that made the bone weak.This is for the long-term effects after the bone has healed, not for the initial break itself.The doctor will also use a code for the disease that caused the bone to break.
This ICD-10-CM code signifies a pathological fracture (a fracture caused by a pre-existing disease weakening the bone) that occurred at a site not specifically listed elsewhere in the ICD-10-CM classification system.The 'XS' seventh character indicates that this is a sequela, meaning the late effect of the initial fracture.The underlying disease that caused the bone weakening must also be coded.
Example 1: A 70-year-old woman with osteoporosis suffers a pathologic fracture of the femur due to a minor fall.The fracture heals with malunion requiring additional treatment.M84.68XP would be used for the subsequent encounter along with codes for osteoporosis and the treatment provided., A 55-year-old man with metastatic bone cancer experiences a pathologic fracture of the vertebra.The fracture heals, but the patient develops long-term back pain. M84.68XS would be used to code the sequela, along with codes for the cancer and pain management., A patient with Paget's disease experiences a pathologic fracture of the tibia.After initial treatment, the patient develops chronic pain and limited mobility. M84.68XS would be coded along with the appropriate code for Paget's disease and any related treatments provided.
Documentation should include the patient's history, physical examination findings (including assessment of pain, swelling, deformity, range of motion, and neurovascular status), imaging studies (X-rays, CT scans, MRI, or DEXA scans), laboratory results (e.g., ESR), and details about the underlying disease process.Treatment plans, including medications, therapies, and surgical interventions, should also be documented.
** Always ensure that the underlying disease causing the pathological fracture is accurately coded alongside M84.68XS.The seventh character (XS) specifically indicates a sequela, implying a subsequent encounter for long-term effects of the initial fracture.Careful review of documentation is crucial for correct coding.
- Revenue Code: Revenue codes will vary depending on the specific services provided and the healthcare setting.Consult your facility's revenue code guidelines.
- RVU: RVUs are not directly associated with ICD-10 codes.RVUs are assigned to procedures (CPT codes) and vary based on factors like geographic location, facility type, and payer.
- Global Days: Not applicable to ICD-10 codes. Global periods are associated with surgical procedures (CPT codes).
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10-CM codes.
- Fee Schedule: Not applicable to ICD-10-CM codes. Fee schedules are associated with procedures (CPT codes).
- Specialties:Orthopedics, Oncology, Rheumatology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, Other Place of Service