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ICD-10 Guide
ICD-10 CodesM84.319

M84.319

Billable

Stress fracture, unspecified shoulder

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

Code Description

ICD-10 M84.319 is a billable code used to indicate a diagnosis of stress fracture, unspecified shoulder.

Key Diagnostic Point:

A stress fracture of the 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 often seen in athletes or individuals who engage in repetitive overhead activities. The shoulder is a complex joint comprised of the humerus, scapula, and clavicle, and stress fractures can occur in any of these bones. Symptoms typically include localized pain, swelling, and tenderness in the shoulder area, which may worsen with activity and improve with rest. Diagnosis is usually confirmed through imaging studies such as X-rays or MRI, which can reveal the fracture line or associated bone edema. Stress fractures are often associated with underlying bone density disorders, such as osteoporosis, where the bone's structural integrity is compromised, making it more susceptible to fractures. Management may involve rest, physical therapy, and in some cases, surgical intervention if conservative measures fail. Understanding the underlying causes, including bone metabolism disorders, is crucial for effective treatment and prevention of future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and symptoms of stress fractures
  • Need for imaging studies to confirm diagnosis
  • Differentiation from other shoulder injuries or fractures
  • Potential underlying conditions like osteoporosis

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document underlying bone density issues
  • Lack of imaging results in the medical record
  • Misclassification of the fracture type

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of injury, imaging results, and treatment plan.

Common Clinical Scenarios

Athletes presenting with shoulder pain after repetitive overhead activities.

Billing Considerations

Ensure documentation reflects the chronic nature of the injury and any underlying bone density issues.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments, rehabilitation plans, and progress notes.

Common Clinical Scenarios

Patients undergoing rehabilitation for shoulder stress fractures.

Billing Considerations

Document the patient's functional limitations and response to therapy.

Coding Guidelines

Inclusion Criteria

Use M84.319 When
  • Follow official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include any relevant history of osteoporosis or other bone density disorders

Exclusion Criteria

Do NOT use M84.319 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73030CPT Code

Radiologic examination, shoulder, complete, including two views

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 accuracy of data collection and reimbursement processes. M84.319 provides a clear designation for unspecified shoulder stress fractures, facilitating better tracking of these injuries.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of stress fractures, improving the accuracy of data collection and reimbursement processes. M84.319 provides a clear designation for unspecified shoulder stress fractures, facilitating better tracking of these injuries.

Reimbursement & Billing Impact

reimbursement processes. M84.319 provides a clear designation for unspecified shoulder stress fractures, facilitating better tracking of these injuries.

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 in the shoulder?

Common causes include repetitive overhead activities, sudden increases in physical activity, and underlying bone density disorders such as osteoporosis.