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.
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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