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ICD-10 Guide
ICD-10 CodesM84.378

M84.378

Billable

Stress fracture, left toe(s)

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

Code Description

ICD-10 M84.378 is a billable code used to indicate a diagnosis of stress fracture, left toe(s).

Key Diagnostic Point:

A stress fracture of the left toe(s) 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 particularly common in the metatarsal bones of the foot, which can be affected by factors such as bone density disorders, including osteoporosis. Osteoporosis is characterized by decreased bone mass and deterioration of bone tissue, leading to increased fragility and susceptibility to fractures. Stress fractures may not always present with acute pain; instead, patients may experience gradual onset of pain that worsens with activity and improves with rest. Diagnosis typically involves a thorough clinical evaluation, imaging studies such as X-rays or MRI, and consideration of the patient's history, including any underlying bone metabolism disorders. Treatment often includes rest, immobilization, and addressing any contributing factors such as nutritional deficiencies or biomechanical issues. Understanding the relationship between stress fractures and bone density is crucial for effective management and prevention of 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
  • Need for precise documentation of location and severity
  • Variability in clinical presentation among patients

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document underlying bone density issues
  • Misclassification of fracture type
  • Lack of follow-up documentation on treatment outcomes

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 foot pain after increased training, patients with osteoporosis experiencing foot pain.

Billing Considerations

Ensure accurate documentation of the fracture site and any contributing factors such as bone density.

Endocrinology

Documentation Requirements

Assessment of bone density and metabolic factors contributing to fracture risk.

Common Clinical Scenarios

Patients with osteoporosis presenting with fractures, evaluation of bone health in postmenopausal women.

Billing Considerations

Document any treatments for osteoporosis that may affect fracture healing.

Coding Guidelines

Inclusion Criteria

Use M84.378 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture's location and any underlying conditions
  • Include details about the patient's history of bone density disorders when applicable

Exclusion Criteria

Do NOT use M84.378 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 evaluating for stress fractures in the foot.

Documentation Requirements

Document the reason for the 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 specificity in coding stress fractures, improving the ability to track and manage these injuries, particularly in populations at risk for osteoporosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding stress fractures, improving the ability to track and manage these injuries, particularly in populations at risk for osteoporosis.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specificity in coding stress fractures, improving the ability to track and manage these injuries, particularly in populations at risk for osteoporosis.

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 an acute fracture?

A stress fracture is a small crack in the bone caused by repetitive stress, while an acute fracture is a complete break in the bone usually resulting from a sudden injury.