ICD 10 Coding Alert

Specialty Corners:

Code 733.11 Expands to 85 Choices in ICD-10

Remember 7th digit for encounter.

How much more can you say about a disease-related humeral fracture (733.11, Pathological fracture of humerus)?

A lot, apparently, based on the fact that ICD-10 provides 85 different codes for that condition.

Simplify: Don’t get too overwhelmed by that number — you really just need to know five codes, but the number explodes to 85 because each of the five codes requires a sixth digit for right/left/unspecified, and each of those fifteen codes requires a seventh digit (there are six choices) to describe the encounter.  

Here are the five base codes you need to know:

  • M80.02-- — Age-related osteoporosis with current pathological fracture, … humerus, …
  • M80.82-- — Other osteoporosis with current pathological fracture, … humerus, …
  • M84.42-- — Pathological fracture, … humerus, …
  • M84.52-- — Pathological fracture in neoplastic disease, … humerus, …
  • M84.62-- — Pathological fracture in other disease, … humerus, …

And here are the sixth digits that you’ll apply to each of the preceding codes:

  • 1 — right
  • 2 — left
  • 9 — unspecified.

Finally, here are the seventh digit choices to describe the encounter

  • 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.

Heads up for pathologists: Although your work determines the final diagnosis of a pathologic fracture, much of the information needed to assign the proper ICD-10 code must come from the referring physician, such as whether the patient has age-related osteoporosis and any encounter information for the seventh digit.

Build a code: Here’s an example of how the base code plus sixth digit plus seventh digit go together to make one of the 85 code choices for pathologic humeral fracture: M80.022A (Age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture).