Version 2024

2024 ICD-10-CM Diagnosis Code M84.58XA

Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture

ICD-10-CM Code:: M84.58XA
ICD-10 Code for:: Pathological fracture in neoplastic disease, oth site, init
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Chronic
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Code Information
Approximate Synonyms
Clinical Classification
Tabular List of Diseases and Injuries
Diagnostic Related Groups Mapping
Convert to ICD-9 Code
Patient Education
Other Codes Used Similar Conditions
Code History

Code Classification

Diseases of the musculoskeletal system and connective tissue
(M00–M99)
- Disorders of bone density and structure
  (M80-M85)
  - Disorder of continuity of bone
    (M84)

M84.58XA is a billable diagnosis code used to specify a medical diagnosis of pathological fracture in neoplastic disease, other specified site, initial encounter for fracture. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

M84.58XA is an initial encounter code, includes a 7th character and should be used while the patient is receiving active treatment for a condition like pathological fracture in neoplastic disease other specified site for fracture. According to ICD-10-CM Guidelines an "initial encounter" doesn't necessarily means "initial visit". The 7th character should be used when the patient is undergoing active treatment regardless if new or different providers saw the patient over the course of a treatment. The appropriate 7th character codes should also be used even if the patient delayed seeking treatment for a condition.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

Malignant neoplasm of vertebra
Mass of thoracic vertebrae
Metastatic malignant neoplasm to vertebral column
Neoplasm of bone of sacrum
Neoplasm of cervical vertebra
Neoplasm of lumbar vertebra
Neoplasm of thoracic vertebra
Pathologic fracture of bone at site of metastatic neoplasm
Pathologic fracture of cervical vertebra at site of neoplasm
Pathologic fracture of lumbar vertebra at site of neoplasm
Pathologic fracture of pelvis at site of neoplasm
Pathologic fracture of sacral vertebra at site of neoplasm
Pathologic fracture of vertebra at site of metastatic neoplasm
Pathologic fracture of vertebra at site of neoplasm
Pathologic fracture of vertebra at site of neoplasm
Pathologic fracture of vertebra at site of neoplasm
Pathologic fracture of vertebra at site of neoplasm
Pathologic fracture of vertebra at site of neoplasm
Pathologic fracture of vertebra at site of neoplasm
Pathological fracture of cervical vertebra
Pathological fracture of lumbar vertebra
Pathological fracture of pelvis
Pathological fracture of sacral vertebra
Pathological fracture of thoracic vertebra
Pathological fracture of thoracic vertebra due to neoplastic disease
Pathological fracture of vertebra
Pathological fracture of vertebra
Pathological fracture of vertebra
Pathological fracture of vertebra
Pathological fracture of vertebra
Pathological fracture of vertebra

Clinical Classification

Clinical Category	CCSR Category Code	Inpatient Default CCSR	Outpatient Default CCSR
Conditions due to neoplasm or the treatment of neoplasm	NEO074	N - Not default inpatient assignment for principal diagnosis or first-listed diagnosis.	N - Not default outpatient assignment for principal diagnosis or first-listed diagnosis.
Pathological fracture, initial encounter	MUS014	Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.	Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

M84.58XA is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
456	SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC	08	8.4294
457	SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC	08	6.0753
458	SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC	08	4.531

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Convert M84.58XA to ICD-9-CM

ICD-9-CM Code: 733.13 - Path fx vertebrae
Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Patient Education

Fractures

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or compound fracture. Fractures commonly happen because of car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the bone.

Symptoms of a fracture are:

Intense pain
Deformity - the limb looks out of place
Swelling, bruising, or tenderness around the injury
Numbness and tingling
Problems moving a limb

You need to get medical care right away for any fracture. An x-ray can tell if your bone is broken. You may need to wear a cast or splint. Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.

[Learn More in MedlinePlus]

Other ICD-10-CM Codes Commonly Used for Similar Conditions

Filter related codes list:

M84 Disorder of continuity of bone.
M84.3 Stress fracture.
M84.30 Stress fracture, unspecified site.
M84.30XA Stress fracture, unspecified site, initial encounter for fracture.
M84.30XD Stress fracture, unspecified site, subsequent encounter for fracture with routine healing.
M84.30XG Stress fracture, unspecified site, subsequent encounter for fracture with delayed healing.
M84.30XK Stress fracture, unspecified site, subsequent encounter for fracture with nonunion.
M84.30XP Stress fracture, unspecified site, subsequent encounter for fracture with malunion.
M84.30XS Stress fracture, unspecified site, sequela.
M84.31 Stress fracture, shoulder.
M84.311 Stress fracture, right shoulder.
M84.311A Stress fracture, right shoulder, initial encounter for fracture.
M84.311D Stress fracture, right shoulder, subsequent encounter for fracture with routine healing.
M84.311G Stress fracture, right shoulder, subsequent encounter for fracture with delayed healing.
M84.311K Stress fracture, right shoulder, subsequent encounter for fracture with nonunion.
M84.311P Stress fracture, right shoulder, subsequent encounter for fracture with malunion.
M84.311S Stress fracture, right shoulder, sequela.
M84.312 Stress fracture, left shoulder.
M84.312A Stress fracture, left shoulder, initial encounter for fracture.
M84.312D Stress fracture, left shoulder, subsequent encounter for fracture with routine healing.
M84.312G Stress fracture, left shoulder, subsequent encounter for fracture with delayed healing.
M84.312K Stress fracture, left shoulder, subsequent encounter for fracture with nonunion.
M84.312P Stress fracture, left shoulder, subsequent encounter for fracture with malunion.
M84.312S Stress fracture, left shoulder, sequela.
M84.319 Stress fracture, unspecified shoulder.
M84.319A Stress fracture, unspecified shoulder, initial encounter for fracture.
M84.319D Stress fracture, unspecified shoulder, subsequent encounter for fracture with routine healing.
M84.319G Stress fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing.
M84.319K Stress fracture, unspecified shoulder, subsequent encounter for fracture with nonunion.
M84.319P Stress fracture, unspecified shoulder, subsequent encounter for fracture with malunion.
M84.319S Stress fracture, unspecified shoulder, sequela.
M84.32 Stress fracture, humerus.
M84.321 Stress fracture, right humerus.
M84.321A Stress fracture, right humerus, initial encounter for fracture.
M84.321D Stress fracture, right humerus, subsequent encounter for fracture with routine healing.
M84.321G Stress fracture, right humerus, subsequent encounter for fracture with delayed healing.
M84.321K Stress fracture, right humerus, subsequent encounter for fracture with nonunion.
M84.321P Stress fracture, right humerus, subsequent encounter for fracture with malunion.
M84.321S Stress fracture, right humerus, sequela.
M84.322 Stress fracture, left humerus.
M84.322A Stress fracture, left humerus, initial encounter for fracture.
M84.322D Stress fracture, left humerus, subsequent encounter for fracture with routine healing.
M84.322G Stress fracture, left humerus, subsequent encounter for fracture with delayed healing.
M84.322K Stress fracture, left humerus, subsequent encounter for fracture with nonunion.
M84.322P Stress fracture, left humerus, subsequent encounter for fracture with malunion.
M84.322S Stress fracture, left humerus, sequela.
M84.329 Stress fracture, unspecified humerus.
M84.329A Stress fracture, unspecified humerus, initial encounter for fracture.
M84.329D Stress fracture, unspecified humerus, subsequent encounter for fracture with routine healing.
M84.329G Stress fracture, unspecified humerus, subsequent encounter for fracture with delayed healing.
M84.329K Stress fracture, unspecified humerus, subsequent encounter for fracture with nonunion.

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.

Footnotes

[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:

The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
The condition places limitations on self-care, independent living, and social interactions.