M84.452A: Pathological fracture, left femur, initial encounter for fracture
M84.452A is a billable, specific ICD-10-CM code for pathological fracture, left femur, initial encounter for fracture. It is valid for submission on a claim.
Check M84.452A with the rest of the claim: free scrubber7th character "A": initial encounter for fracture
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 M84.452A
A category’s note binds every code beneath it.
Written on M84.4: Pathological fracture, not elsewhere classified
Excludes2 inherited from the categories above M84.452A
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
M84.452A risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 402 Hip Fracture/Dislocation0.467 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
M84.452A is named in 18 Medicare coverage policies: 11 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under M84.452
- M84.452DPathological fracture, left femur, subsequent encounter for fracture with routine healing
- M84.452GPathological fracture, left femur, subsequent encounter for fracture with delayed healing
- M84.452KPathological fracture, left femur, subsequent encounter for fracture with nonunion
- M84.452PPathological fracture, left femur, subsequent encounter for fracture with malunion
- M84.452SPathological fracture, left femur, sequela