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ICD-10 Guide
ICD-10 CodesM84.369

M84.369

Billable

Stress fracture, unspecified tibia and fibula

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

Code Description

ICD-10 M84.369 is a billable code used to indicate a diagnosis of stress fracture, unspecified tibia and fibula.

Key Diagnostic Point:

A stress fracture of the tibia and fibula is a small crack in the bone that occurs due to repetitive force or overuse, often seen in athletes or individuals with increased physical activity. This condition is characterized by localized pain that worsens with weight-bearing activities and may improve with rest. The tibia, or shinbone, is the larger of the two bones in the lower leg, while the fibula is the thinner bone located alongside it. Stress fractures can arise from various factors, including inadequate bone density, osteoporosis, and poor biomechanics. In patients with osteoporosis, the bones become weak and brittle, increasing the risk of fractures even from minor stress. Diagnosis typically involves a thorough clinical evaluation, imaging studies such as X-rays or MRI, and consideration of the patient's history of bone density disorders. Treatment often includes rest, modification of activities, and in some cases, physical therapy to strengthen the surrounding muscles and improve bone health. Understanding the underlying causes of stress fractures is crucial for effective management and prevention of future occurrences.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Need for differential diagnosis to rule out other fractures
  • Potential overlap with other bone density disorders
  • Documentation of patient history and activity level

Audit Risk Factors

  • Inadequate documentation of the cause of the stress fracture
  • Failure to document bone density status
  • Lack of imaging results in the medical record
  • Insufficient detail on the patient's activity level

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes on the mechanism of injury, imaging results, and treatment plan.

Common Clinical Scenarios

Athletes presenting with lower leg pain, patients with a history of osteoporosis experiencing new pain.

Billing Considerations

Ensure that all imaging studies are documented and correlate with clinical findings.

Endocrinology

Documentation Requirements

Assessment of bone density via DEXA scans and documentation of any underlying metabolic bone disorders.

Common Clinical Scenarios

Patients with osteoporosis presenting with stress fractures.

Billing Considerations

Document any medications affecting bone density, such as corticosteroids.

Coding Guidelines

Inclusion Criteria

Use M84.369 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the fracture's location and type
  • Include any relevant history of osteoporosis or other bone density disorders

Exclusion Criteria

Do NOT use M84.369 When
  • Exclude codes for acute fractures or other specified conditions

Related ICD-10 Codes

Related CPT Codes

73630CPT Code

Radiologic examination, tibia and fibula

Clinical Scenario

Used when imaging is performed to confirm a stress fracture diagnosis.

Documentation Requirements

Document the reason for imaging and findings.

Specialty Considerations

Orthopedic specialists should ensure imaging correlates with clinical findings.

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 analyze these injuries. M84.369 provides a clear designation for unspecified stress fractures, aiding in research and treatment planning.

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 analyze these injuries. M84.369 provides a clear designation for unspecified stress fractures, aiding in research and treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of stress fractures, improving the ability to track and analyze these injuries. M84.369 provides a clear designation for unspecified stress fractures, aiding in research and treatment planning.

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 are the common causes of stress fractures?

Common causes include repetitive activities, sudden increases in physical activity, inadequate footwear, and underlying bone density disorders such as osteoporosis.

How can stress fractures be prevented?

Prevention strategies include gradual increases in activity levels, proper footwear, strength training, and ensuring adequate calcium and vitamin D intake.