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Pathology/Lab Coding Alert

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Check These Diagnoses for Pathologic Femur Fracture

Published on Tue Sep 09, 2014

Question: Our pathologist examined a femur neck specimen with a fracture from the patient’s right leg, and diagnosed metastatic prostate cancer. The patient has completed the prostate cancer treatment and, until this, had no other evidence of disease. How will we code this scenario in ICD-9 and ICD-10?

Answer: You should code the findings for the pathologic fracture with 733.14 (Pathological fracture of neck of femur) under ICD-9, and in ICD-10, M84.551A (Pathological fracture in neoplastic disease, right femur, initial encounter for fracture).
 
You should also report a personal history code for the prostate cancer: That’s V10.46 (Personal history of malignant neoplasm of prostate) for ICD-9 and Z85.46 (Personal history of malignant neoplasm of prostate) for ICD-10.
 
Finally, because the pathologist specified that the neoplasm involved is metastatic prostate cancer, you should also report 198.5 (Secondary malignant neoplasm of bone and bone marrow) in ICD-9, and C79.51 (Secondary malignant neoplasm of bone) in ICD-10. 

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