Path fx in oth disease, unsp shldr, subs for fx w nonunion

This code signifies a fracture of the shoulder that occurred due to an underlying disease process, rather than trauma, and is currently experiencing a failure of bone healing (nonunion). This is a follow-up encounter for the management of this specific pathological fracture.

Use this code for patients presenting for ongoing treatment of a shoulder pathological fracture where the bone fragments have not united, and the underlying cause is an unspecified disease. Documentation should clearly state "pathological fracture," "shoulder," "nonunion," and indicate a subsequent encounter for fracture care.

• Ensure documentation specifies "pathological fracture" and the underlying disease if known; otherwise, "in other disease" is appropriate.
• Verify laterality (left, right, bilateral) is not specified in the documentation, as this code is for an "unspecified shoulder."
• Confirm the encounter is for ongoing fracture treatment, not initial care or sequelae, to justify the "K" seventh character.