M84.612G — Pathological fracture in other disease, left shoulder, subsequent encounter for fracture with delayed healing
M84.612G is a billable, specific ICD-10-CM code for pathological fracture in other disease, left shoulder, subsequent encounter for fracture with delayed healing. It is valid for submission on a claim.
7th character "G" — subsequent encounter for fracture with delayed healing
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
Risk adjustment
M84.612G 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.
Medicare coverage
M84.612G is named in 7 Medicare coverage policies — 1 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 M84.612. If M84.612G is not quite right, the correct code is usually one of these.
- M84.612APathological fracture in other disease, left shoulder, initial encounter for fracture
- M84.612DPathological fracture in other disease, left shoulder, subsequent encounter for fracture with routine healing
- M84.612KPathological fracture in other disease, left shoulder, subsequent encounter for fracture with nonunion
- M84.612PPathological fracture in other disease, left shoulder, subsequent encounter for fracture with malunion
- M84.612SPathological fracture in other disease, left shoulder, sequela
Questions about M84.612G
- Is M84.612G a billable ICD-10-CM code?
- Yes. M84.612G is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M84.612G 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).