M84.472P: Pathological fracture, left ankle, subsequent encounter for fracture with malunion
M84.472P is a billable, specific ICD-10-CM code for pathological fracture, left ankle, subsequent encounter for fracture with malunion. It is valid for submission on a claim.
Check M84.472P with the rest of the claim: free scrubber7th character "P": subsequent encounter for fracture with malunion
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 M84.472P
A category’s note binds every code beneath it.
Written on M84.4: Pathological fracture, not elsewhere classified
Excludes2 inherited from the categories above M84.472P
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.
Medicare coverage
M84.472P is named in 8 Medicare coverage policies: 1 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 M84.472
- M84.472APathological fracture, left ankle, initial encounter for fracture
- M84.472DPathological fracture, left ankle, subsequent encounter for fracture with routine healing
- M84.472GPathological fracture, left ankle, subsequent encounter for fracture with delayed healing
- M84.472KPathological fracture, left ankle, subsequent encounter for fracture with nonunion
- M84.472SPathological fracture, left ankle, sequela