M84.659A: Pathological fracture in other disease, hip, unspecified, initial encounter for fracture
M84.659A is a billable, specific ICD-10-CM code for pathological fracture in other disease, hip, unspecified, initial encounter for fracture. It is valid for submission on a claim.
Check M84.659A with the rest of the claim: free scrubber7th character "A": initial encounter for fracture
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 inherited from the categories above M84.659A
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above M84.659A
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
Risk adjustment
M84.659A 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
M84.659A is named in 8 Medicare coverage policies: 1 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58883Billing 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
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under M84.659
- M84.659DPathological fracture in other disease, hip, unspecified, subsequent encounter for fracture with routine healing
- M84.659GPathological fracture in other disease, hip, unspecified, subsequent encounter for fracture with delayed healing
- M84.659KPathological fracture in other disease, hip, unspecified, subsequent encounter for fracture with nonunion
- M84.659PPathological fracture in other disease, hip, unspecified, subsequent encounter for fracture with malunion
- M84.659SPathological fracture in other disease, hip, unspecified, sequela