Is M84.4 a billable ICD-10-CM code?

No. M84.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M84.4 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Disorders of bone density and structure (M80-M85).

What cannot be coded together with M84.4?

M84.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

M84.4

M84.4 — Pathological fracture, not elsewhere classified

Non-billable headerICD-10-CM

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.

collapsed vertebra NEC (M48.5)
pathological fracture in neoplastic disease (M84.5-)
pathological fracture in osteoporosis (M80.-)
pathological fracture in other disease (M84.6-)
stress fracture (M84.3-)
traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)

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

Other codes that can never be billed with M84.4

These codes carry an Excludes1 note pointing at M84.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M84.4 alone.

M48.4Fatigue fracture of vertebra
M48.5Collapsed vertebra, not elsewhere classified
M80Osteoporosis with current pathological fracture
M84.3Stress fracture

Risk adjustment

M84.4 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead M84.4

9 child codes. Green means billable.

Related codes at this level

Codes that share M84. If M84.4 is not quite right, the correct code is usually one of these.

Questions about M84.4

Is M84.4 a billable ICD-10-CM code?: No. M84.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M84.4 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Disorders of bone density and structure (M80-M85).
What cannot be coded together with M84.4?: M84.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.