2026 ICD-10-CM Diagnosis Code M84.479APathological fracture, unspecified toe(s), initial encounter for fracture

ICD-10-CM Codes›M00–M99›M80-M85›M84

ICD-10-CM M84.479A
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

M84.479A is a billable ICD-10-CM diagnosis code for pathological fracture, unspecified toe(s), initial encounter for fracture. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 542 through 544. The code is flagged as an unspecified code, since codes identifying laterality exist in the same family. Coders also document this condition as pathological fracture of phalanx of foot. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pathological fracture, initial encounter.

Code Identity

ICD-10-CM Code
M84.479A
Billable Status
Yes — Valid for Submission
Code Describes
Pathological fracture, unspecified toe(s), initial encounter for fracture
Short Description
Pathological fracture, unsp toe(s), init encntr for fracture
Parent Code
M84.479
Pathological fracture, unspecified toe(s)

Code Classification

ChapterM00–M99Diseases of the musculoskeletal system and connective tissue
SectionM80-M85Disorders of bone density and structure
CategoryM84Disorder of continuity of bone
This CodeM84.479APathological fracture, unspecified toe(s), initial encounter for fracture

Code EditsBilling

Medicare Code Editor checks that affect claim validity for M84.479A.

Unspecified codes
Unspecified codes exist in the ICD-10-CM classification for circumstances when documentation in the medical record does not provide the level of detail needed to support reporting a more specific code. However, in the inpatient setting, there should generally be very limited and rare circumstances for which the laterality (right, left, bilateral) of a condition is unable to be documented and reported. The following pages contain the list of unspecified ICD-10-CM diagnosis codes for which there is a more specific code to identify laterality (right, left, bilateral) within that code family.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Pathological fracture of phalanx of foot

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR MUS014
Pathological fracture, initial encounter
Default principal diagnosis: inpatient Yes · outpatient Yes

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 M84.479A to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
733.19 Path fx oth specif site
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About M84.479AOverview

Is M84.479A (Pathological fracture, unspecified toe(s)) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report pathological fracture, unspecified toe(s), initial encounter for fracture on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What does the 7th character A in M84.479A mean?

The final character A marks the initial encounter: use it while the patient is receiving active treatment for pathological fracture, unspecified toe(s), such as an emergency visit or first evaluation.

What MS-DRG does M84.479A group to?

When pathological fracture, unspecified toe(s), initial encounter for fracture is the principal diagnosis on an inpatient stay, it groups to MS-DRG 542, 543, 544, with relative weights from 0.7546 to 1.7665 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of M84.479A?

Under the General Equivalence Mappings, pathological fracture, unspecified toe(s), initial encounter for fracture converts to ICD-9-CM 733.19 (path fx oth specif site). The mapping is approximate, so confirm the match fits the documentation.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.