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ICD-10 Guide
ICD-10 CodesM84.311

M84.311

Billable

Stress fracture, right shoulder

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

Code Description

ICD-10 M84.311 is a billable code used to indicate a diagnosis of stress fracture, right shoulder.

Key Diagnostic Point:

A stress fracture of the right shoulder is a small crack in the bone that occurs due to repetitive force or overuse, rather than a single traumatic event. This condition is particularly common in athletes and individuals who engage in high-impact activities. The shoulder, comprising the humerus, scapula, and clavicle, can be susceptible to stress fractures, especially in the humeral head or neck. Factors contributing to stress fractures include low bone density, osteoporosis, and inadequate nutrition, which can impair bone metabolism and strength. Patients may present with localized pain, swelling, and tenderness in the shoulder area, often exacerbated by movement or weight-bearing activities. Diagnosis typically involves a thorough clinical evaluation, imaging studies such as X-rays or MRI, and assessment of bone density. Treatment focuses on rest, activity modification, and possibly physical therapy to strengthen surrounding muscles and improve function. In cases where osteoporosis is a contributing factor, addressing the underlying bone density disorder is crucial to 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.
  • Need for precise documentation of the location and nature of the fracture.
  • Potential for co-existing conditions that may complicate coding.

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury.
  • Failure to document co-existing conditions like osteoporosis.
  • Misclassification of the fracture type.
  • Lack of follow-up documentation to support ongoing treatment.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on the patient's history, physical examination findings, imaging results, and treatment plan.

Common Clinical Scenarios

Athletes presenting with shoulder pain after increased training intensity.

Billing Considerations

Ensure that the documentation clearly differentiates between stress fractures and other shoulder injuries.

Endocrinology

Documentation Requirements

Assessment of bone density, history of osteoporosis, and management plans for bone health.

Common Clinical Scenarios

Patients with a history of osteoporosis presenting with shoulder pain.

Billing Considerations

Document any medications affecting bone density, such as bisphosphonates.

Coding Guidelines

Inclusion Criteria

Use M84.311 When
  • Follow the official ICD
  • CM guidelines for coding fractures, ensuring accurate documentation of the fracture type, location, and any underlying conditions
  • Include any relevant history of osteoporosis or other bone density disorders

Exclusion Criteria

Do NOT use M84.311 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

Radiologic examination, shoulder

Clinical Scenario

Used to confirm the diagnosis of a stress fracture.

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 specific coding of stress fractures, improving the ability to track and manage these conditions effectively. It emphasizes the importance of documenting the cause and nature of the fracture.

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 the cause and nature of the fracture.

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 emphasizes the importance of documenting the cause and nature of the fracture.

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 typically results from a single traumatic event.