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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.30

M84.30

Billable

Stress fracture, unspecified site

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

Code Description

ICD-10 M84.30 is a billable code used to indicate a diagnosis of stress fracture, unspecified 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. Unlike acute fractures, stress fractures develop gradually and may not be immediately apparent on X-rays. They are commonly associated with conditions that affect bone density and metabolism, such as osteoporosis, which weakens bones and increases the risk of fractures. Stress fractures can occur in various bones, including the foot, shin, and pelvis, but when the site is unspecified, it indicates that the exact location of the fracture has not been documented. Diagnosis typically involves a combination of patient history, physical examination, and imaging studies, such as MRI or bone scans, which can reveal changes in the bone that are not visible on standard X-rays. Treatment usually involves rest, modification of activities, and sometimes the use of supportive devices. Understanding the underlying bone density disorders is crucial, as patients with osteoporosis or other metabolic bone diseases may require more intensive management to prevent further fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified site may lead to ambiguity in documentation.
  • Requires understanding of underlying conditions like osteoporosis.
  • Differentiating from other types of fractures can be challenging.
  • Need for precise documentation to support the diagnosis.

Audit Risk Factors

  • Inadequate documentation of the fracture site.
  • Failure to document underlying bone density disorders.
  • Misuse of unspecified codes when specific codes are available.
  • Lack of imaging studies to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on the mechanism of injury, physical examination findings, and imaging results.

Common Clinical Scenarios

Athletes presenting with pain after increased training, patients with osteoporosis experiencing new pain.

Billing Considerations

Ensure that the site of the fracture is documented clearly to avoid ambiguity.

Endocrinology

Documentation Requirements

Assessment of bone density, history of metabolic bone disease, and treatment plans.

Common Clinical Scenarios

Patients with osteoporosis presenting with stress fractures, evaluation of fracture risk.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use M84.30 When
  • According to ICD
  • 10 guidelines, M84
  • 30 should be used when the specific site of the stress fracture is not documented
  • Coders should ensure that the diagnosis is supported by clinical documentation and imaging studies
  • It is important to note that if the site becomes known later, a more specific code should be used

Exclusion Criteria

Do NOT use M84.30 When
No specific exclusions found.

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 clearly indicate findings related to stress fractures.

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 injuries. M84.30 serves as a catch-all for unspecified sites, but coders are encouraged to seek specificity when possible.

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 injuries. M84.30 serves as a catch-all for unspecified sites, but coders are encouraged to seek specificity when possible.

Reimbursement & Billing Impact

reimbursement.

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

When should I use M84.30?

Use M84.30 when a stress fracture is diagnosed but the specific site is not documented. Ensure that all other clinical information supports the diagnosis.