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Pain Management Coding Alert

Reader Question:

Drill Down for Pathological Fracture Dx

Question: If a patient suffers from age-related osteoporosis with a current pathological arm fracture, what ICD-10 code should I choose for the patient?

Iowa Subscriber

Answer: It depends on what part of the arm is fractured, and which side the fracture is on — if you can find out that information.

First: Check if the fracture was in the patient’s humerus or forearm — or both. Also, check the notes to see if the fracture was on the right or left side.

Then: Use one of the following codes, or combination of codes, to represent the fracture:

  • M80.021X (Age-related osteoporosis with current pathological fracture, right humerus)
  • M80.022X (… left humerus)
  • M80.029X (… unspecified humerus)
  • M80.031X (Age-related osteoporosis with current pathological fracture, right forearm)
  • M80.032X (… left forearm)
  • M80.039X (… unspecified forearm).

X marks the (7th) spot: Note the seventh character “X” in each of the above codes; this is a placeholder that you’ll fill in with the appropriate character from the list at the head of the M80 (Osteoporosis with current pathological fracture) code set:

  • A — initial encounter for fracture
  • D — subsequent encounter for fracture with routine healing
  • G — subsequent encounter for fracture with delayed healing
  • K — subsequent encounter for fracture with nonunion
  • P — subsequent encounter for fracture with malunion
  • S — sequela.