Pathological fracture, unsp shoulder, subs for fx w malunion

This code signifies a pathological fracture of an unspecified shoulder, meaning the bone broke due to an underlying disease rather than trauma, and the fracture is now healing incorrectly (malunion). This specific encounter is for ongoing treatment or follow-up of this previously diagnosed and treated pathological fracture with malunion.

Apply this code when a patient presents for follow-up care, cast change, physical therapy, or other ongoing management of a pathological shoulder fracture that has healed in a misaligned position. Documentation should clearly state "pathological fracture," "unspecified shoulder," "malunion," and indicate that this is not the initial treatment for the fracture.

• Ensure documentation specifies "pathological fracture" and not a traumatic fracture.
• Verify the encounter type is "subsequent" and not "initial" or "sequela."
• Code also the underlying disease causing the pathological fracture (e.g., osteoporosis, neoplasm).