M84.6

M84.6: Pathological fracture in other disease

Non-billable headerICD-10-CM

M84.6 is a non-billable header ICD-10-CM code for pathological fracture in other 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 M84.6:

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: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

pathological fracture in osteoporosis (M80.-)

Code also

Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.

underlying condition

Excludes2 inherited from the categories above M84.6

Not part of this code, but both may be coded when both are present.

Written on M84: Disorder of continuity of bone

traumatic fracture of bone-see fracture, by site

Other codes that can never be billed with M84.6

Their own Excludes1 notes name this code, so the conflict is not listed above.

M48.4Fatigue fracture of vertebra
M48.5Collapsed vertebra, not elsewhere classified
M84.4Pathological fracture, not elsewhere classified

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Code history

Unchanged in every release from FY2024 to FY2027.

Code to one of these instead M84.6

9 child codes. Green means billable.