Is M84.463 a billable ICD-10-CM code?

No. M84.463 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M84.463 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 M84.463?

M84.463 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M84.463 (M84.4) and apply to it just the same.

M84.463

M84.463 — Pathological fracture, right fibula

Non-billable headerICD-10-CMright

M84.463 is a non-billable header ICD-10-CM code for pathological fracture, right 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 M84.463

These are not written on M84.463, but they bind it: a note on a category applies to every code beneath it. Billing M84.463 with anything listed here is a denial.

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 M84.463

Also inherited, and the opposite of Excludes1: these conditions are not part of M84.463, but a patient can have both, so you may code both.

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

M84.463 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 history

M84.463 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead M84.463

6 child codes. Green means billable.

Related codes at this level

Codes that share M84.46. If M84.463 is not quite right, the correct code is usually one of these.

Questions about M84.463

Is M84.463 a billable ICD-10-CM code?: No. M84.463 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M84.463 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 M84.463?: M84.463 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M84.463 (M84.4) and apply to it just the same.