Pathological fracture, right toe(s), sequela

This code signifies a pathological fracture of the right toe(s) where the acute injury has healed, but residual effects or complications from that fracture persist. A pathological fracture occurs due to an underlying disease weakening the bone, rather than from trauma. The "sequela" indicates that this code is used for conditions that are the late effects of the initial fracture.

Apply this code when documentation clearly indicates a patient is being treated for a long-term complication or residual condition directly resulting from a previously healed pathological fracture of the right toe(s). This includes chronic pain, deformity, nonunion, or malunion that is a direct consequence of the original pathological fracture. Supporting documentation should specify the laterality (right toe), the pathological nature of the original fracture, and the sequela status.

• Ensure the documentation explicitly states "sequela" or describes a chronic condition directly linked to a past pathological fracture.
• Do not use for acute pathological fractures; those would be coded with the appropriate initial or subsequent encounter codes.
• Always code the underlying disease responsible for the pathological fracture first, if still active and relevant to the current encounter.