M84.469A Pathological fracture, unspecified tibia and fibula, initial encounter for fracture

Billable ICD-10-CM code, FY2026.

Built from M84.469 with 7th character A (initial encounter for fracture).

Applies from M84 Disorder of continuity of bone

Excludes2 (not included here)

• traumatic fracture of bone-see fracture, by site

Applies from M84.4 Pathological fracture, not elsewhere classified

Applicable to

• Chronic fracture
• Pathological fracture NOS

Excludes1 (never code together)

• collapsed vertebra NEC (M48.5)
• pathological fracture in neoplastic disease (M84.5-)
• pathological fracture in osteoporosis (M80.-)
• pathological fracture in other disease (M84.6-)
• stress fracture (M84.3-)
• traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)

Excludes2 (not included here)

• personal history of (healed) pathological fracture (Z87.311)

7th character note

• The appropriate 7th character is to be added to each code from subcategory M84.4:

7th character required

• 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

Risk adjustment (HCC)

• RxHCC V08: HCC 87 — Osteoporosis, Vertebral and Pathological Fractures

Medicare Code Edits (MCE v43.1 (April 2026))

• Unspecified code (laterality): Unspecified codes for which a more specific code identifying laterality (right, left, bilateral) exists within the same code family.

Code annotations containing back-references to M84.469A

Back-references to M84.4

• Type 1 Excludes: M48.4 Fatigue fracture of vertebra ("pathological fracture NOS (M84.4-)")
• Type 1 Excludes: M48.5 Collapsed vertebra, not elsewhere classified ("pathological fracture NOS (M84.4-)")
• Type 1 Excludes: M80 Osteoporosis with current pathological fracture ("pathological fracture NOS (M84.4)")
• Type 1 Excludes: M84.3 Stress fracture ("pathological fracture NOS (M84.4.-)")

Nearby codes

• M84.464G Pathological fracture, left fibula, subsequent encounter for fracture with delayed healing
• M84.464K Pathological fracture, left fibula, subsequent encounter for fracture with nonunion
• M84.464P Pathological fracture, left fibula, subsequent encounter for fracture with malunion
• M84.464S Pathological fracture, left fibula, sequela
• M84.469 Pathological fracture, unspecified tibia and fibula
• M84.469A Pathological fracture, unspecified tibia and fibula, initial encounter for fracture (this code)
• M84.469D Pathological fracture, unspecified tibia and fibula, subsequent encounter for fracture with routine healing
• M84.469G Pathological fracture, unspecified tibia and fibula, subsequent encounter for fracture with delayed healing
• M84.469K Pathological fracture, unspecified tibia and fibula, subsequent encounter for fracture with nonunion
• M84.469P Pathological fracture, unspecified tibia and fibula, subsequent encounter for fracture with malunion
• M84.469S Pathological fracture, unspecified tibia and fibula, sequela