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ICD-10 Guide
ICD-10 CodesM84.3

M84.3

Billable

Stress fracture

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

Code Description

ICD-10 M84.3 is a billable code used to indicate a diagnosis of stress fracture.

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. Unlike acute fractures, stress fractures develop gradually and are often associated with underlying bone density disorders such as osteoporosis. These fractures typically occur in weight-bearing bones, including the tibia, metatarsals, and femur. Patients may present with localized pain that worsens with activity and improves with rest. Diagnosis is primarily clinical, supported by imaging studies such as X-rays or MRI, which can reveal the fracture line or bone edema. Management involves rest, modification of activities, and in some cases, the use of supportive devices. In patients with osteoporosis, the risk of stress fractures increases due to decreased bone density and compromised bone metabolism, necessitating a comprehensive approach to treatment that may include pharmacological interventions to enhance bone density. Understanding the relationship between stress fractures and bone health is crucial for effective prevention and management.

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 presentation and symptoms among patients
  • Need for precise documentation of activity levels and risk factors

Audit Risk Factors

  • Inadequate documentation of the patient's activity level
  • Failure to document underlying bone density disorders
  • Misclassification of stress fractures as acute fractures
  • Lack of imaging studies to support diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of symptoms, imaging results, and treatment plans.

Common Clinical Scenarios

Athletes presenting with localized pain in weight-bearing bones.

Billing Considerations

Documentation must clearly differentiate stress fractures from acute fractures.

Endocrinology

Documentation Requirements

Assessment of bone density, history of osteoporosis, and treatment plans.

Common Clinical Scenarios

Patients with osteoporosis presenting with stress fractures.

Billing Considerations

Focus on the metabolic aspects of bone health and treatment compliance.

Coding Guidelines

Inclusion Criteria

Use M84.3 When
  • According to ICD
  • 10 guidelines, M84
  • 3 should be used when a stress fracture is diagnosed
  • It is important to document the specific location of the fracture and any underlying conditions such as osteoporosis

Exclusion Criteria

Do NOT use M84.3 When
  • Exclusion criteria include acute fractures and pathological fractures

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 indicate the presence of a stress fracture.

Specialty Considerations

Orthopedic specialists often order these imaging studies.

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 emphasizes 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 emphasizes the importance of documenting underlying bone health issues.

Reimbursement & Billing Impact

reimbursement and to avoid denials.

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 develops gradually due to repetitive stress on the bone, while an acute fracture occurs suddenly due to trauma or injury. Stress fractures are often associated with overuse and underlying bone density issues.