Podiatry Coding & Billing Alert

Question: My podiatrist saw a patient who fractured his right foot. The patient was diagnosed with left upper lobe carcinoma five years ago, and then several months ago, he was diagnosed with metastatic bone cancer (from the lung). The patient’s foot fracture is a result of the metastatic cancer. The patient’s lung cancer has already been treated with radiation, and the patient no longer has any evidence of an existing primary malignancy. Is this a pathologic or traumatic fracture? And, what diagnosis codes should I report?

Florida Subscriber

Answer: This is an example of a pathologic fracture, which occurs when a bone breaks in an area that is weakened by another disease process. Causes of weakened bone include tumors, infection, and certain inherited bone disorders.

There are dozens of diseases and conditions that can lead to a pathologic fracture or dislocations. A pathologic fracture usually occurs with normal activities. Patients may be doing very routine activities when their bone suddenly fractures or dislocates. The reason for a fracture is that the underlying disease process weakens the bone to the point where the bone is unable to perform its normal function.

ICD-10-CM has three pathologic fracture categories:

• Due to neoplastic disease
• Due to osteoporosis
• Due to other specified disease.

Solution: In this particular scenario, the patient’s pathologic fracture in his right foot was due to neoplastic disease. Therefore, you should report the following codes:

• M84.574A (Pathological fracture in neoplastic disease, right foot, initial encounter for fracture)
• C79.51 (Secondary malignant neoplasm of bone)
• Z85.118 (Personal history of other malignant neoplasm of bronchus and lung)
• Z92.3 (Personal history of irradiation).