M84.419: Pathological fracture, unspecified shoulder
M84.419 is a non-billable header ICD-10-CM code for pathological fracture, unspecified shoulder. 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 inherited from the categories above M84.419
A category’s note binds every code beneath it.
Written on M84.4: Pathological fracture, not elsewhere classified
Excludes2 inherited from the categories above M84.419
Not part of this code, but both may be coded when both are present.
Written on M84.4: Pathological fracture, not elsewhere classified
- personal history of (healed) pathological fracture (Z87.311)
Written on M84: Disorder of continuity of bone
- traumatic fracture of bone-see fracture, by site
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 M84.419
6 child codes. Green means billable.
- M84.419APathological fracture, unspecified shoulder, initial encounter for fracture
- M84.419DPathological fracture, unspecified shoulder, subsequent encounter for fracture with routine healing
- M84.419GPathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing
- M84.419KPathological fracture, unspecified shoulder, subsequent encounter for fracture with nonunion
- M84.419PPathological fracture, unspecified shoulder, subsequent encounter for fracture with malunion
- M84.419SPathological fracture, unspecified shoulder, sequela