M84.46

M84.46: Pathological fracture, tibia and fibula

Non-billable headerICD-10-CM

M84.46 is a non-billable header ICD-10-CM code for pathological fracture, tibia and fibula. 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 M84.46

A category’s note binds every code beneath it.

Written on M84.4: Pathological fracture, not elsewhere classified

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 inherited from the categories above M84.46

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 M84.46

5 child codes. Green means billable.