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M84.4 Non-Billable Code

Pathological fracture, not elsewhere classified

Chapter Classification

Chapter 13 Diseases of the musculoskeletal system and connective tissue (M00-M99)

Section Detail

M80-M85 Disorders of bone density and structure (M80-M85)

Code Hierarchy

This code is a child of M84.

As a non-billable code, it requires more specific digits to be used on a medical claim.

Coding Guidelines & Notes

excludes1
  • collapsed vertebra NEC (M48.5)
  • pathological fracture in neoplastic disease (M84.5-)
  • pathological fracture in osteoporosis (M80.-)
  • pathological fracture in other disease (M84.6-)
  • stress fracture (M84.3-)
  • traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)
excludes2
  • personal history of (healed) pathological fracture (Z87.311)
sevenChrDef
  • {'char': 'A', 'text': 'initial encounter for fracture'}
  • {'char': 'D', 'text': 'subsequent encounter for fracture with routine healing'}
  • {'char': 'G', 'text': 'subsequent encounter for fracture with delayed healing'}
  • {'char': 'K', 'text': 'subsequent encounter for fracture with nonunion'}
  • {'char': 'P', 'text': 'subsequent encounter for fracture with malunion'}
  • {'char': 'S', 'text': 'sequela'}
sevenChrNote
  • The appropriate 7th character is to be added to each code from subcategory M84.4:

More Specific Diagnosis Codes

This code is not billable as it requires a higher level of specificity. Select a more specific code below.

  • M84.40 - Pathological fracture, unspecified site Billable
  • M84.41 - Pathological fracture, shoulder
  • M84.42 - Pathological fracture, humerus
  • M84.43 - Pathological fracture, ulna and radius
  • M84.44 - Pathological fracture, hand and fingers
  • M84.45 - Pathological fracture, femur and pelvis
  • M84.46 - Pathological fracture, tibia and fibula
  • M84.47 - Pathological fracture, ankle, foot and toes
  • M84.48 - Pathological fracture, other site Billable

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