M84.6 — Pathological fracture in other disease
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
Other codes that can never be billed with M84.6
These codes carry an Excludes1 note pointing at M84.6. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M84.6 alone.
Risk adjustment
M84.6 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 M84.6
9 child codes. Green means billable.
- M84.60Pathological fracture in other disease, unspecified site
- M84.61Pathological fracture in other disease, shoulder
- M84.62Pathological fracture in other disease, humerus
- M84.63Pathological fracture in other disease, ulna and radius
- M84.64Pathological fracture in other disease, hand
- M84.65Pathological fracture in other disease, pelvis and femur
- M84.66Pathological fracture in other disease, tibia and fibula
- M84.67Pathological fracture in other disease, ankle and foot
- M84.68Pathological fracture in other disease, other site
Related codes at this level
Codes that share M84. If M84.6 is not quite right, the correct code is usually one of these.
Questions about M84.6
- Is M84.6 a billable ICD-10-CM code?
- No. M84.6 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does M84.6 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).
- What cannot be coded together with M84.6?
- M84.6 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.