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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.31

M84.31

Billable

Stress fracture, shoulder

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M84.31 is a billable code used to indicate a diagnosis of stress fracture, shoulder.

Key Diagnostic Point:

A stress fracture of the shoulder is a small crack in the bone that occurs due to repetitive force or overuse, rather than a single traumatic event. This condition is often associated with underlying bone density disorders such as osteoporosis, where the bones become weak and brittle, making them more susceptible to fractures. In the shoulder, stress fractures can occur in the humerus or scapula, particularly in athletes or individuals engaged in repetitive overhead activities. Symptoms typically include localized pain, swelling, and tenderness in the shoulder area, which may worsen with activity. Diagnosis is usually confirmed through imaging studies such as X-rays or MRI, which can reveal the fracture and assess the surrounding bone density. Treatment often involves rest, physical therapy, and in some cases, the use of braces or surgical intervention if conservative measures fail. Understanding the relationship between stress fractures and bone metabolism is crucial, as conditions like osteoporosis can significantly increase the risk of such injuries, necessitating a comprehensive approach to management and prevention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between stress fractures and other types of fractures
  • Understanding the impact of underlying bone density disorders
  • Variability in clinical presentation based on patient activity level
  • Need for precise documentation of symptoms and imaging findings

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document underlying bone density disorders
  • Misclassification of the type of fracture
  • Lack of imaging results in the medical record

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on the patient's history, physical examination findings, and imaging results.

Common Clinical Scenarios

Athletes presenting with shoulder pain after repetitive overhead activities.

Billing Considerations

Ensure that the documentation clearly states the diagnosis and any underlying conditions affecting bone density.

Endocrinology

Documentation Requirements

Assessment of bone density and management of osteoporosis.

Common Clinical Scenarios

Patients with osteoporosis presenting with stress fractures.

Billing Considerations

Documenting the patient's bone health status and any treatments for osteoporosis.

Coding Guidelines

Inclusion Criteria

Use M84.31 When
  • According to ICD
  • 10 guidelines, M84
  • 31 should be used when a stress fracture of the shoulder is confirmed through imaging
  • It is important to document any underlying conditions such as osteoporosis, as these may affect treatment and management

Exclusion Criteria

Do NOT use M84.31 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

Radiologic examination, shoulder, complete, including 2 views

Clinical Scenario

Used to confirm the diagnosis of a stress fracture in the shoulder.

Documentation Requirements

Include imaging results and interpretation in the medical record.

Specialty Considerations

Orthopedic specialists should ensure that imaging is clearly linked to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of stress fractures, improving the ability to track and manage these injuries. M84.31 provides a clear distinction from other fracture types, facilitating better patient care and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of stress fractures, improving the ability to track and manage these injuries. M84.31 provides a clear distinction from other fracture types, facilitating better patient care and resource allocation.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between a stress fracture and a regular fracture?

A stress fracture is a small crack in the bone caused by repetitive force or overuse, while a regular fracture typically results from a single traumatic event. Stress fractures often occur in weight-bearing bones and may not be visible on initial X-rays.