Pathological fracture, hip, unspecified, initial encounter for fracture. M84. 459A is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
81.
Fractures in ICD-10Initial (use seventh digit “A”)Subsequent (use seventh digit “D”)Sequela (use seventh digit “S”)Jan 9, 2016
Subsequent encounter (D) is used for encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase (e.g., cast change or removal, an x-ray to check healing status of fracture, removal of external or internal fixation device, ...
ICD-10 | Pain in right hip (M25. 551)
ICD-Code M81. 0 is a billable ICD-10 code used for healthcare diagnosis reimbursement of Age-Related Osteoporosis without Current Pathological Fracture. Its corresponding ICD-9 code is 733.
ICD-10-CM defines subsequent encounters as “encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase.Apr 1, 2014
When the patient is following the plan—that is subsequent. If the doctor needs to adjust the plan of care—for example, if the patient has a setback or must returns to the OR—the care becomes active, again.”Dec 1, 2015
Use 7th character D, subsequent encounter, “for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.” When a code has an option for a subsequent encounter 7th character, you should use that character instead of ...Feb 22, 2021
733.82 - Nonunion of fracture.
A malunion occurs when a fractured bone heals in an abnormal position, which can lead to impaired function of the bone or limb and make it look like it is 'bent'. Similarly, a nonunion is the result of a fractured bone failing to heal after an extended period of time – in some cases over a period of 9 to 12 months.
The 7th character represents the type of encounter, or phase of treatment; this could be an initial encounter, a subsequent encounter, or a sequela (previously known as a late effect).Nov 14, 2019
Initial is interpreted as active treatment. When the visit is for the purpose of deciding what treatment is required to repair the fracture, it is an initial encounter. Likewise, when the visit results in a changed active plan of care, it is an initial encounter. Initial visit examples:
Fracture coding can be a challenge for both physicians and coders, but its effect on hierarchical condition code (HCC) funding in Medicare Advantage, as well as health plan Star ratings, leaves little room for speculation. Knowing how ICD-10 delineates initial and subsequent visits is key.
She is the manager of Risk Adjustment & Quality Assurance for a Medicare Advantage in Houston, Texas, and is a member of the Houston, Texas, local chapter.