M84.551A — Pathological fracture in neoplastic disease, right femur, initial encounter for fracture
M84.551A is a billable, specific ICD-10-CM code for pathological fracture in neoplastic disease, right femur, initial encounter for fracture. It is valid for submission on a claim.
7th character "A" — initial encounter for fracture
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
Risk adjustment
M84.551A 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.
Medicare coverage
M84.551A is named in 19 Medicare coverage policies — 13 listing it as supporting medical necessity, and 6 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A58865Billing 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
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
Related codes at this level
Codes that share M84.551. If M84.551A is not quite right, the correct code is usually one of these.
- M84.551DPathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with routine healing
- M84.551GPathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with delayed healing
- M84.551KPathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with nonunion
- M84.551PPathological fracture in neoplastic disease, right femur, subsequent encounter for fracture with malunion
- M84.551SPathological fracture in neoplastic disease, right femur, sequela
Questions about M84.551A
- Is M84.551A a billable ICD-10-CM code?
- Yes. M84.551A is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M84.551A 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).