Pathological fracture, unspecified shoulder, sequela

This code signifies a pathological fracture of an unspecified shoulder that has resulted in a long-term complication or condition. A pathological fracture occurs due to a disease process weakening the bone, rather than from trauma. The "sequela" indicates that the acute phase of the fracture has passed, and the patient is now experiencing residual effects.

Use this code when documentation clearly indicates a pathological fracture of the shoulder (without specifying left or right) and the patient is being treated for a late effect or complication directly attributable to that fracture. This code is appropriate for follow-up care, rehabilitation, or management of chronic issues stemming from the original pathological fracture. Documentation should specify "sequela," "late effect," or similar terminology.

• Ensure the documentation specifies "pathological fracture" and not a traumatic fracture.
• Only use this code for unspecified shoulder involvement; if left or right is documented, a more specific code is required.
• This code is for the sequela of the fracture; for the initial encounter or active treatment of the acute pathological fracture, a different code from the M84.4 category would be appropriate.