2027 ICD-10-CM Diagnosis Code M84.461DPathological fracture, right tibia, subsequent encounter for fracture with routine healing
M84.461D is a billable ICD-10-CM diagnosis code for pathological fracture, right tibia, subsequent encounter for fracture with routine healing. The 7th character D means subsequent encounter for fracture with routine healing, used during routine care in the healing or recovery phase. 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 of right tibia. 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 of right tibia
- Pathological fracture of tibia
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M84.461D: 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 this code
- Gsubsequent encounter for fracture with delayed healing
- 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 M84.461D, its category, or a range that includes it.
Excludes1 4
These codes carry an Excludes1 note naming M84.461D: 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 M84.461D to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M84.461DOverview
Is M84.461D (Pathological fracture, right tibia) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report pathological fracture, right tibia, subsequent encounter for fracture with routine healing on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character D in M84.461D mean?
The final character D marks a subsequent encounter: use it for routine care while the pathological fracture, right tibia is healing, after active treatment has ended. In this category the CMS Tabular List defines D as "subsequent encounter for fracture with routine healing".
What MS-DRG does M84.461D group to?
When pathological fracture, right tibia, subsequent encounter for fracture with routine 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 M84.461D be reported with M48.5?
Not as a rule. The Excludes1 note at M84.4, which applies to M84.461D, 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 M84.461D?
Under the General Equivalence Mappings, pathological fracture, right tibia, subsequent encounter for fracture with routine healing converts to ICD-9-CM V54.26 (aftrcare path fx low leg). The mapping is approximate, so confirm the match fits the documentation.
