Coding and coverage · ICD-10-CM

M84 › M84.5 › M84.55

M84.559 Pathological fracture in neoplastic disease, hip, unspecified

Not billable (header)Chapter 13

This code needs a 7th character (use X as a placeholder for missing characters).

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7th character codes

  • M84.559A Pathological fracture in neoplastic disease, hip, unspecified, initial encounter for fracture
  • M84.559D Pathological fracture in neoplastic disease, hip, unspecified, subsequent encounter for fracture with routine healing
  • M84.559G Pathological fracture in neoplastic disease, hip, unspecified, subsequent encounter for fracture with delayed healing
  • M84.559K Pathological fracture in neoplastic disease, hip, unspecified, subsequent encounter for fracture with nonunion
  • M84.559P Pathological fracture in neoplastic disease, hip, unspecified, subsequent encounter for fracture with malunion
  • M84.559S Pathological fracture in neoplastic disease, hip, unspecified, sequela

Instructional notes

Chapter 13

Excludes2Not included here: the patient may have both; report both when both are present.
  • 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)
Notes
  • Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition

M84

Excludes2Not included here: the patient may have both; report both when both are present.
  • traumatic fracture of bone-see fracture, by site

M84.5

Code also
  • underlying neoplasm
7th charactersThe appropriate 7th character is to be added to each code from subcategory M84.5:
  • 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

Chapter 13: Diseases of the musculoskeletal system and connective tissue · M80-M94 Osteopathies and chondropathies (M80-M94)

Source: ICD-10-CM FY 2027 code descriptions and tabular list (CMS and CDC National Center for Health Statistics), effective 2026-10-01 through 2027-09-30 · CMS ICD-10 files. HCC mapping: CMS-HCC V28, payment year 2027. As of 2026-11-04.

Coverage and payment depend on the claim details; confirm with the Medicare Administrative Contractor.