M84.469
Pathological fracture, unspecified tibia and fibula
M84.469 is a non-billable ICD-10-CM code header for pathological fracture, unspecified tibia and fibula. Report a more specific code from it instead. It is part of the FY2027 code set, effective October 1, 2026. A 7th character is required to complete the code. Its coding notes include 6 Excludes1 entries and 12 Excludes2 entries.
7th character
Category M84.4 requires a 7th character.
Guidelines tip
From the FY2027 Official Guidelines. ICD10Ref adds no rules of its own.
7th character A applies while the patient is in active treatment, regardless of which provider sees them. D is for routine care during healing after active treatment ends.
Excludes1
Not coded here. The listed conditions generally should not be reported together.
Excludes2
Not included here. Both codes may be reported if the patient has both conditions.
- personal history of (healed) pathological fracture (Z87.311)
- traumatic fracture of bone-see fracture, by site
Also from chapter/block level (10 notes)
- 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
Also from chapter/block level (1 note)
- Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition
7th-character codes under M84.469 6
- M84.469APathological fracture, unspecified tibia and fibula, initial encounter for fractureBillable
- M84.469DPathological fracture, unspecified tibia and fibula, subsequent encounter for fracture with routine healingBillable
- M84.469GPathological fracture, unspecified tibia and fibula, subsequent encounter for fracture with delayed healingBillable
- M84.469KPathological fracture, unspecified tibia and fibula, subsequent encounter for fracture with nonunionBillable
- M84.469PPathological fracture, unspecified tibia and fibula, subsequent encounter for fracture with malunionBillable
- M84.469SPathological fracture, unspecified tibia and fibula, sequelaBillable