M84.5 — Pathological fracture in neoplastic disease
M84.5 is a non-billable header ICD-10-CM code for pathological fracture in neoplastic disease. 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 M84.5:
- 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
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
- underlying neoplasm
Other codes that can never be billed with M84.5
These codes carry an Excludes1 note pointing at M84.5. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M84.5 alone.
Risk adjustment
M84.5 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 to one of these instead M84.5
9 child codes. Green means billable.
- M84.50Pathological fracture in neoplastic disease, unspecified site
- M84.51Pathological fracture in neoplastic disease, shoulder
- M84.52Pathological fracture in neoplastic disease, humerus
- M84.53Pathological fracture in neoplastic disease, ulna and radius
- M84.54Pathological fracture in neoplastic disease, hand
- M84.55Pathological fracture in neoplastic disease, pelvis and femur
- M84.56Pathological fracture in neoplastic disease, tibia and fibula
- M84.57Pathological fracture in neoplastic disease, ankle and foot
- M84.58Pathological fracture in neoplastic disease, other specified site
Related codes at this level
Codes that share M84. If M84.5 is not quite right, the correct code is usually one of these.
Questions about M84.5
- Is M84.5 a billable ICD-10-CM code?
- No. M84.5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does M84.5 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).