M84.4: Pathological fracture, not elsewhere classified
M84.4 is a non-billable header ICD-10-CM code for pathological fracture, not elsewhere classified. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.
This code requires a 7th character
The appropriate 7th character is to be added to each code from subcategory M84.4:
- A
- initial encounter for fracture
- D
- subsequent encounter for fracture with routine healing
- G
- subsequent encounter for fracture with delayed healing
- K
- subsequent encounter for fracture with nonunion
- P
- subsequent encounter for fracture with malunion
- S
- sequela
Excludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Excludes2: not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- personal history of (healed) pathological fracture (Z87.311)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Chronic fracture
- Pathological fracture NOS
Excludes2 inherited from the categories above M84.4
Not part of this code, but both may be coded when both are present.
Written on M84: Disorder of continuity of bone
- traumatic fracture of bone-see fracture, by site
Other codes that can never be billed with M84.4
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Code history
Unchanged in every release from FY2024 to FY2027.
Code to one of these instead M84.4
9 child codes. Green means billable.
- M84.40Pathological fracture, unspecified site
- M84.41Pathological fracture, shoulder
- M84.42Pathological fracture, humerus
- M84.43Pathological fracture, ulna and radius
- M84.44Pathological fracture, hand and fingers
- M84.45Pathological fracture, femur and pelvis
- M84.46Pathological fracture, tibia and fibula
- M84.47Pathological fracture, ankle, foot and toes
- M84.48Pathological fracture, other site