M84.569A Pathological fracture in neoplastic disease, unspecified tibia and fibula, initial encounter for fracture

Billable ICD-10-CM code, FY2026.

Built from M84.569 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 M84.5 Pathological fracture in neoplastic disease

Code also

• underlying neoplasm

7th character note

• The appropriate 7th character is to be added to each code from subcategory M84.5:

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 M84.569A

Back-references to M84.5

• Type 1 Excludes: M84.4 Pathological fracture, not elsewhere classified ("pathological fracture in neoplastic disease (M84.5-)")

Nearby codes

• M84.564G Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with delayed healing
• M84.564K Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with nonunion
• M84.564P Pathological fracture in neoplastic disease, left fibula, subsequent encounter for fracture with malunion
• M84.564S Pathological fracture in neoplastic disease, left fibula, sequela
• M84.569 Pathological fracture in neoplastic disease, unspecified tibia and fibula
• M84.569A Pathological fracture in neoplastic disease, unspecified tibia and fibula, initial encounter for fracture (this code)
• M84.569D Pathological fracture in neoplastic disease, unspecified tibia and fibula, subsequent encounter for fracture with routine healing
• M84.569G Pathological fracture in neoplastic disease, unspecified tibia and fibula, subsequent encounter for fracture with delayed healing
• M84.569K Pathological fracture in neoplastic disease, unspecified tibia and fibula, subsequent encounter for fracture with nonunion
• M84.569P Pathological fracture in neoplastic disease, unspecified tibia and fibula, subsequent encounter for fracture with malunion
• M84.569S Pathological fracture in neoplastic disease, unspecified tibia and fibula, sequela