M84.529A — Pathological fracture in neoplastic disease, unspecified humerus, initial encounter for fracture
Is M84.529A billable?
Yes, but M84.529A will trip a Medicare edit. M84.529A is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists M84.529A under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
M84.529A at a glance
| Code | M84.529A |
|---|---|
| Description | Pathological fracture in neoplastic disease, unspecified humerus, initial encounter for fracture |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "A" | initial encounter for fracture |
What does the 7th character "A" mean in M84.529A?
In M84.529A, the 7th character A means initial encounter for fracture. The 7th character is required for M84.529A to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
What Medicare edits apply to M84.529A?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name M84.529A directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does M84.529A group to?
M84.529A sits in MDC 08 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 542Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with MCCmedical
- 543Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with CCmedical
- 544Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy without CC/MCCmedical
As a secondary diagnosis, M84.529A is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is M84.529A listed in the Alphabetic Index?
The Alphabetic Index lists these routes under M84.52, the nearest indexed parent of M84.529A. Use them to find the family, then select the specific code.
- Fracture, pathological › due to › neoplastic disease NEC › humerus (pathologic)
Excludes2 — not included here — inherited from Chapter 13
The conditions below are not part of M84.529A, but a patient may have both at the same time. When documentation supports it, M84.529A and the excluded code may both be reported.
- 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)
Excludes2 — not included here — inherited from M84
The conditions below are not part of M84.529A, but a patient may have both at the same time. When documentation supports it, M84.529A and the excluded code may both be reported.
- traumatic fracture of bone-see fracture, by site
Code also — inherited from M84.5
Two codes may be needed to describe the condition fully. Whether M84.529A is sequenced first depends on the reason for the encounter.
- underlying neoplasm
How long has M84.529A existed?
M84.529A has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.