Pathological fracture, right shoulder, sequela

This code signifies a pathological fracture of the right shoulder that has occurred due to an underlying disease process, not trauma, and is being addressed as a late effect or complication of the original fracture. It indicates that the patient is experiencing residual problems or conditions directly resulting from a previously healed or treated pathological fracture in this specific anatomical location.

Apply this code when documentation clearly indicates a patient is presenting with a sequela (e.g., chronic pain, nonunion, malunion, functional limitation) directly attributable to a past pathological fracture of the right shoulder. The medical record must specify that the fracture was pathological in nature and that the current encounter addresses a long-term consequence of that fracture.

• Ensure the documentation explicitly states "sequela" or describes a late effect of a pathological fracture, not a traumatic one.
• Always sequence this code after the code(s) for the specific sequela being treated (e.g., M25.511 for chronic right shoulder pain).
• Verify that the laterality (right shoulder) is clearly documented; do not use this code for left shoulder or unspecified shoulder sequelae.