M84.469
Pathological fracture, unspecified tibia and fibula
Choose the additional character
M84.469 needs more characters to be billable. Pick the specific code below.
- 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
This code does not map to a risk-adjusting HCC in the loaded models.
Coding notes
Excludes 1 never coded together · Excludes 2 may co-exist
collapsed vertebra NEC (M48.5) pathological fracture in neoplastic disease (M84.5-) pathological fracture in osteoporosis (M80.-) pathological fracture in other disease (M84.6-) stress fracture (M84.3-) traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)
personal history of (healed) pathological fracture (Z87.311)
Chronic fracture Pathological fracture NOS
The appropriate 7th character is to be added to each code from subcategory M84.4:
| Character | Meaning |
|---|---|
| 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 |
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)
Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition (M00-M25) Arthropathies (M00-M25) Includes: Disorders affecting predominantly peripheral (limb) joints (M40-M54) Dorsopathies (M40-M54) (M60-M79) Soft tissue disorders (M60-M79) (M80-M94) Osteopathies and chondropathies (M80-M94)
Official Guidelines for M84.469
FY 2026 ›Sections that reference M84.469
Sections whose FY 2026 text names M84.469, its M84 category, or a range containing it — the chapter guidance above is the authoritative source.