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ICD-10 Guide
ICD-10 CodesM84.38

M84.38

Billable

Stress fracture, other site

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

Code Description

ICD-10 M84.38 is a billable code used to indicate a diagnosis of stress fracture, other site.

Key Diagnostic Point:

A stress fracture is a small crack in a bone that occurs due to repetitive force or overuse, often seen in athletes or individuals with increased physical activity. The term 'other site' indicates that the fracture is not located in the commonly affected areas such as the foot or shin. Stress fractures can arise from various factors including inadequate bone density, particularly in patients with osteoporosis or other bone metabolism disorders. Osteoporosis, characterized by reduced bone mass and deterioration of bone tissue, significantly increases the risk of fractures, including stress fractures. These fractures may not present with immediate symptoms, often leading to delayed diagnosis. Patients may report localized pain that worsens with activity and improves with rest. Diagnosis typically involves imaging studies such as X-rays or MRI to confirm the presence of a fracture. Treatment focuses on rest, modification of activities, and in some cases, the use of supportive devices. Addressing underlying bone density issues is crucial to prevent recurrence and promote healing.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential sites for stress fractures complicating documentation.
  • Need for precise clinical details to differentiate from other fracture types.
  • Potential overlap with other conditions affecting bone density.
  • Variability in treatment protocols based on patient history and comorbidities.

Audit Risk Factors

  • Inadequate documentation of the fracture site.
  • Failure to document underlying bone density disorders.
  • Misclassification of stress fractures as acute fractures.
  • Lack of follow-up documentation on treatment and recovery.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports and clinical notes describing the fracture site and treatment plan.

Common Clinical Scenarios

Athletes presenting with localized pain and a history of increased activity.

Billing Considerations

Ensure documentation reflects the chronic nature of stress fractures and any underlying osteoporosis.

Endocrinology

Documentation Requirements

Bone density test results and assessments of metabolic bone diseases.

Common Clinical Scenarios

Patients with osteoporosis presenting with stress fractures.

Billing Considerations

Documenting the relationship between metabolic bone disorders and fracture risk is essential.

Coding Guidelines

Inclusion Criteria

Use M84.38 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the fracture site and any underlying conditions

Exclusion Criteria

Do NOT use M84.38 When
  • Exclude acute fractures and ensure that the stress fracture is not a result of a pathological condition

Related ICD-10 Codes

Related CPT Codes

73630CPT Code

Radiologic examination, bone, other than spine

Clinical Scenario

Used to confirm the diagnosis of a stress fracture.

Documentation Requirements

Radiology report must specify the findings related to the stress fracture.

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 manage these conditions effectively. M84.38 provides granularity that aids in understanding the epidemiology of stress fractures in various populations.

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. M84.38 provides granularity that aids in understanding the epidemiology of stress fractures in various populations.

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. M84.38 provides granularity that aids in understanding the epidemiology of stress fractures in various populations.

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, and underlying bone density disorders such as osteoporosis.

How can stress fractures be prevented?

Prevention strategies include gradual increases in activity levels, proper footwear, and addressing any underlying bone health issues.