2027 ICD-10-CM Diagnosis Code M84.469SPathological fracture, unspecified tibia and fibula, sequela
M84.469S is a billable ICD-10-CM diagnosis code for pathological fracture, unspecified tibia and fibula, sequela. The 7th character S marks it as a sequela code, which reports a problem that remains after the original condition has resolved. 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 - lower leg. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pathological, stress and atypical fractures, sequela.
Code Identity
Code Classification
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Pathological fracture - lower leg
- Pathological fracture of fibula
- Pathological fracture of tibia
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M84.469S: 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
- Ksubsequent encounter for fracture with nonunion
- Psubsequent encounter for fracture with malunion
- Ssequela this code
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name M84.469S, its category, or a range that includes it.
Excludes1 4
These codes carry an Excludes1 note naming M84.469S: 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 M84.469S to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M84.469SOverview
What is the ICD-10 code for pathological fracture, unspecified tibia and fibula, sequela?
The ICD-10-CM code for pathological fracture, unspecified tibia and fibula, sequela is M84.469S (sometimes written as M84469S). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is M84.469S (Pathological fracture, unspecified tibia and fibula) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report pathological fracture, unspecified tibia and fibula, sequela on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character S in M84.469S mean?
The final character S makes this a sequela code: it reports a lingering problem that remains after the pathological fracture, unspecified tibia and fibula itself has resolved, not the original event.
What MS-DRG does M84.469S group to?
When pathological fracture, unspecified tibia and fibula, sequela 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 M84.469S be reported with M48.5?
Not as a rule. The Excludes1 note at M84.4, which applies to M84.469S, 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).
