M84.569K — Pathological fracture in neoplastic disease, unspecified tibia and fibula, subsequent encounter for fracture with nonunion
Is M84.569K billable?
Yes, but M84.569K will trip a Medicare edit. M84.569K is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists M84.569K 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.
More specific alternatives
- M84.561KPathological fracture in neoplastic disease, right tibia, subsequent encounter for fracture with nonunion
- M84.562KPathological fracture in neoplastic disease, left tibia, subsequent encounter for fracture with nonunion
- M84.563KPathological fracture in neoplastic disease, right fibula, subsequent encounter for fracture with nonunion
- M84.564KPathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with nonunion
M84.569K at a glance
| Code | M84.569K |
|---|---|
| Description | Pathological fracture in neoplastic disease, unspecified tibia and fibula, subsequent encounter for fracture with nonunion |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "K" | subsequent encounter for fracture with nonunion |
What does the 7th character "K" mean in M84.569K?
In M84.569K, the 7th character K means subsequent encounter for fracture with nonunion. The 7th character is required for M84.569K to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
What Medicare edits apply to M84.569K?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name M84.569K 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 M84.569K group to?
M84.569K 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.
- 564Other Musculoskeletal System and Connective Tissue Diagnoses with MCCmedical
- 565Other Musculoskeletal System and Connective Tissue Diagnoses with CCmedical
- 566Other Musculoskeletal System and Connective Tissue Diagnoses without CC/MCCmedical
As a secondary diagnosis, M84.569K is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is M84.569K listed in the Alphabetic Index?
The Alphabetic Index lists these routes under M84.56, the nearest indexed parent of M84.569K. Use them to find the family, then select the specific code.
- Fracture, pathological › due to › neoplastic disease NEC › fibula (pathologic)
- Fracture, pathological › due to › neoplastic disease NEC › tibia (pathologic)
Excludes2 — not included here — inherited from Chapter 13
The conditions below are not part of M84.569K, but a patient may have both at the same time. When documentation supports it, M84.569K 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 M84.569K, but a patient may have both at the same time. When documentation supports it, M84.569K 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 M84.569K is sequenced first depends on the reason for the encounter.
- underlying neoplasm
How long has M84.569K existed?
M84.569K 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.