M84.68 — Pathological fracture in other disease, other site
M84.68 is a non-billable header ICD-10-CM code for pathological fracture in other disease, other 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 M84.6:
- 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
Other codes that can never be billed with M84.68
These codes carry an Excludes1 note pointing at M84.68. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M84.68 alone.
Risk adjustment
M84.68 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 M84.68 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 M84.68.
- Fracture, pathological›due to›specified disease NEC›neck
- Fracture, pathological›due to›specified disease NEC›rib
- Fracture, pathological›due to›specified disease NEC›skull
- Fracture, pathological›due to›specified disease NEC›vertebra
Code to one of these instead M84.68
6 child codes. Green means billable.
- M84.68XAPathological fracture in other disease, other site, initial encounter for fracture
- M84.68XDPathological fracture in other disease, other site, subsequent encounter for fracture with routine healing
- M84.68XGPathological fracture in other disease, other site, subsequent encounter for fracture with delayed healing
- M84.68XKPathological fracture in other disease, other site, subsequent encounter for fracture with nonunion
- M84.68XPPathological fracture in other disease, other site, subsequent encounter for fracture with malunion
- M84.68XSPathological fracture in other disease, other site, sequela
Related codes at this level
Codes that share M84.6. If M84.68 is not quite right, the correct code is usually one of these.
- 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
Questions about M84.68
- Is M84.68 a billable ICD-10-CM code?
- No. M84.68 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does M84.68 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).