M84.511APathological fracture in neoplastic disease, right shoulder, initial encounter for fracture

M84.511A is the ICD-10-CM diagnosis code for pathological fracture in neoplastic disease, right shoulder, initial encounter for fracture. It belongs to category M84 (disorder of continuity of bone), block M80-M85 (disorders of bone density and structure) and chapter 13 (diseases of the musculoskeletal system and connective tissue). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.

The 7th character "A" means initial encounter for fracture: use it while the patient is receiving active treatment for the condition.

As a secondary diagnosis it is a CC (complication or comorbidity), which can move an inpatient stay into the "with CC" MS-DRG of its family, unless the principal diagnosis excludes it.

In MS-DRG v44.0, it is part of the grouping logic for DRG 542 (Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with MCC, relative weight 1.7211), DRG 543 (Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with CC, relative weight 1.006), DRG 544 (Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy without CC/MCC, relative weight 0.7406), DRG 791 (Prematurity with Major Problems, relative weight 4.1075) and DRG 793 (Full Term Neonate with Major Problems, relative weight 4.2195), in MDC 08 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) and MDC 15 (Newborns and Other Neonates with Conditions Originating in the Perinatal Period), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.

It has been part of ICD-10-CM since the code set took effect on October 1, 2015 and hasn't changed since.

Before ICD-10, this condition was coded in ICD-9-CM as 733.19 (pathologic fracture of other specified site).