M84.474A
Pathological fracture, right foot, initial encounter for fracture
M84.474A (also written M84474A) is a billable ICD-10-CM diagnosis code for pathological fracture, right foot, initial encounter for fracture. It is part of the FY2027 code set, effective October 1, 2026. It is one of the 928 codes in category M84 (Disorder of continuity of bone). Its 7th character, A, means initial encounter for fracture. 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)
Care settings
How CMS programs treat this code. These are CMS claim edits and list entries, not coverage or eligibility rules.
Home Health Primary
Accepted as the primary (principal) diagnosis on a home health claim. The Home Health Grouper assigns it to the Musculoskeletal Rehabilitation clinical group.
Source: CMS Home Health Grouper Software v07.2.26, effective October 1, 2026Hospital CC
Counts as a complication or comorbidity (CC) when reported as a secondary diagnosis on an inpatient claim. It does not count when the principal diagnosis is one of the 214 codes in its exclusion list. Some MS-DRGs also ignore a CC or MCC that defines the DRG.
Source: CMS MS-DRG Definitions Manual v44, effective October 1, 2026, Appendix CNotes
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