Is M84.58 a billable ICD-10-CM code?

No. M84.58 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M84.58 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).

M84.58

M84.58 — Pathological fracture in neoplastic disease, other specified site

Non-billable headerICD-10-CM

M84.58 is a non-billable header ICD-10-CM code for pathological fracture in neoplastic disease, other specified site. 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

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Pathological fracture in neoplastic disease, vertebrae

Other codes that can never be billed with M84.58

These codes carry an Excludes1 note pointing at M84.58. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M84.58 alone.

M48.4Fatigue fracture of vertebra
M48.5Collapsed vertebra, not elsewhere classified

Risk adjustment

M84.58 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.

How M84.58 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to M84.58.

Fracture, pathological›due to›neoplastic disease NEC›neck
Fracture, pathological›due to›neoplastic disease NEC›rib
Fracture, pathological›due to›neoplastic disease NEC›skull
Fracture, pathological›due to›neoplastic disease NEC›specified site NEC
Fracture, pathological›due to›neoplastic disease NEC›vertebra

Code to one of these instead M84.58

6 child codes. Green means billable.

Related codes at this level

Codes that share M84.5. If M84.58 is not quite right, the correct code is usually one of these.

Questions about M84.58

Is M84.58 a billable ICD-10-CM code?: No. M84.58 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M84.58 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).