2027 ICD-10-CM Diagnosis Code M84.419GPathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing
M84.419G is a billable ICD-10-CM diagnosis code for pathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing. The 7th character G means subsequent encounter for fracture with delayed healing. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 559 through 561. Coders also document this condition as pathological fracture - shoulder. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pathological fracture, subsequent encounter.
Code Identity
Code Classification
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Pathological fracture - shoulder
- Pathological fracture of clavicle
- Pathological fracture of scapula
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M84.419G: its own notes plus those printed at M84.4, M84, and Chapter 13. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- personal history of (healed) pathological fracture (Z87.311)
- traumatic fracture of bone-see fracture, by site
- arthropathic psoriasis (L40.5-)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- compartment syndrome (traumatic) (T79.A-)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Notes
General instructions on how these codes are used.
- Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition
7th Character
Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.
- The appropriate 7th character is to be added to each code from subcategory M84.4:
- Ainitial encounter for fracture
- Dsubsequent encounter for fracture with routine healing
- Gsubsequent encounter for fracture with delayed healing this code
- Ksubsequent encounter for fracture with nonunion
- Psubsequent encounter for fracture with malunion
- Ssequela
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name M84.419G, its category, or a range that includes it.
Excludes1 4
These codes carry an Excludes1 note naming M84.419G: they are not reported together with it, unless the two conditions are unrelated.
- M48.4 Fatigue fracture of vertebrapathological fracture NOS (M84.4-) names M84.4-, which includes this code
- M48.5 Collapsed vertebra, not elsewhere classifiedpathological fracture NOS (M84.4-) names M84.4-, which includes this code
- M80 Osteoporosis with current pathological fracturepathological fracture NOS (M84.4) names M84.4, which includes this code
- M84.3 Stress fracturepathological fracture NOS (M84.4.-) names M84.4.-, which includes this code
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Fractures, Spontaneous
fractures occurring as a result of disease of a bone or from some undiscoverable cause, and not due to trauma. (dorland, 27th ed)
Patient EducationClinical
Fractures
A fracture is a break in a bone. Fractures are usually caused by injuries. Since they can sometimes be serious, it's important to get medical care right away if you think you have a fracture.
The full article covers:
- What is a fracture?
- What are the different types of fractures?
- What causes fractures?
- What are the symptoms of a fracture?
- How are fractures diagnosed?
- What are the treatments for fractures?
- Can fractures be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert M84.419G to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M84.419GOverview
Is M84.419G (Pathological fracture, unspecified shoulder) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report pathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character G in M84.419G mean?
The final character G reports a subsequent encounter where the pathological fracture, unspecified shoulder is healing more slowly than expected. In this category the CMS Tabular List defines G as "subsequent encounter for fracture with delayed healing".
What MS-DRG does M84.419G group to?
When pathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing is the principal diagnosis on an inpatient stay, it groups to MS-DRG 559, 561, 560, with relative weights from 0.8258 to 1.8087 depending on complications. Higher weights mean higher Medicare reimbursement.
Can M84.419G be reported with M48.5?
Not as a rule. The Excludes1 note at M84.4, which applies to M84.419G, lists "collapsed vertebra NEC (M48.5)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What is the ICD-9 equivalent of M84.419G?
Under the General Equivalence Mappings, pathological fracture, unspecified shoulder, subsequent encounter for fracture with delayed healing converts to ICD-9-CM V54.21 (aftercare path fx up arm). The mapping is approximate, so confirm the match fits the documentation.
