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M84.541G vs M84.542G

M84.541G (Pathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with delayed healing) compared with M84.542G (Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with delayed healing), from the official CMS tabular data. M84.541G and M84.542G code the same condition on opposite sides. MedCoder-derived

Can these codes be reported together?

Review

Laterality relationship

M84.541G
Right
Pathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with delayed healing
M84.542G
Left
Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with delayed healing

What we found

Same condition, opposite side.M84.541G and M84.542G name the same condition on opposite sides of the body.

Same category and title, differing only in which side is affected — the documentation decides which one applies, and a bilateral code is reported only where the code set provides one.

What to review

Report the side the documentation names. Where the code set provides a bilateral code and both sides are documented, use it instead of the pair.

Guide: Laterality codingCheck these on a claim

Why it matters

These codes share a category and title and differ only in the side affected. The documentation decides which applies, and a bilateral code is reported only where the code set provides one.

Source / rule

ICD-10-CM tabular list (laterality variant derived from the code title)

Side by side

M84.541GPathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with delayed healingM84.542GPathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with delayed healing
Billing statusBillableBillable
ClassificationM00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
DefinitionPathological fracture in neoplastic disease, right hand, subsequent encounter for fracture with delayed healing is a billable ICD-10-CM diagnosis code (M84.541G).Pathological fracture in neoplastic disease, left hand, subsequent encounter for fracture with delayed healing is a billable ICD-10-CM diagnosis code (M84.542G).
7th characterThe appropriate 7th character is to be added to each code from subcategory M84.5:The appropriate 7th character is to be added to each code from subcategory M84.5:
Excludes2
traumatic fracture of bone-see fracture, by site
traumatic fracture of bone-see fracture, by site
Code also
underlying neoplasm
underlying neoplasm

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

Derived from the official CMS ICD-10-CM tabular data (FY2026). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources