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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.374

M84.374

Billable

Stress fracture, right foot

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

Code Description

ICD-10 M84.374 is a billable code used to indicate a diagnosis of stress fracture, right foot.

Key Diagnostic Point:

A stress fracture in the right foot is a small crack in one of the bones caused by repetitive force or overuse, often seen in athletes or individuals with increased physical activity. This condition is particularly common in the metatarsals, the bones in the midfoot, and can occur due to factors such as inadequate bone density, osteoporosis, or improper footwear. Stress fractures are characterized by localized pain that worsens with activity and improves with rest. Diagnosis typically involves a thorough clinical examination and imaging studies, such as X-rays or MRI, to confirm the presence of a fracture. Patients may also present with swelling and tenderness in the affected area. Treatment usually includes rest, ice, and possibly immobilization of the foot to allow for healing. In cases where underlying bone density disorders are present, such as osteoporosis, additional management may be necessary to address the overall bone health and prevent future fractures.

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
  • Documentation of the patient's activity level and history
  • Need for imaging studies to confirm diagnosis

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document underlying bone density issues
  • 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 foot pain after increased training, elderly patients with a history of osteoporosis.

Billing Considerations

Ensure that all relevant imaging studies are documented and that the patient's activity level is clearly stated.

Endocrinology

Documentation Requirements

Documentation of bone density tests and management of osteoporosis.

Common Clinical Scenarios

Patients with osteoporosis presenting with stress fractures.

Billing Considerations

Include details on the patient's bone health management and any medications affecting bone density.

Coding Guidelines

Inclusion Criteria

Use M84.374 When
  • Follow the official ICD
  • CM coding guidelines for fractures, ensuring accurate documentation of the fracture type and location
  • Include any relevant history of osteoporosis or other bone density disorders

Exclusion Criteria

Do NOT use M84.374 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73630CPT Code

Radiologic examination, foot; complete, minimum of 3 views

Clinical Scenario

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

Documentation Requirements

Document the reason for imaging and findings.

Specialty Considerations

Orthopedic specialists should ensure imaging results are included in the patient's record.

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 conditions effectively. It has also emphasized the importance of documenting underlying bone health issues.

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 conditions effectively. It has also emphasized the importance of documenting underlying bone health issues.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of stress fractures, improving the ability to track and manage these conditions effectively. It has also emphasized the importance of documenting underlying bone health issues.

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 is typically the result of a single traumatic event. Stress fractures often require different management strategies focused on rest and rehabilitation.