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ICD-10 Guide
ICD-10 CodesM84.321

M84.321

Billable

Stress fracture, right humerus

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

Code Description

ICD-10 M84.321 is a billable code used to indicate a diagnosis of stress fracture, right humerus.

Key Diagnostic Point:

A stress fracture of the right humerus 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 high-impact activities. Stress fractures are more common in bones that bear weight or are subjected to repetitive stress, such as the humerus in the upper arm. Factors contributing to stress fractures include low bone density, osteoporosis, and inadequate nutrition, particularly calcium and vitamin D. Patients may present with localized pain, swelling, and tenderness in the upper arm, which may worsen with activity and improve with rest. Diagnosis typically involves a thorough clinical evaluation, imaging studies such as X-rays or MRI, and assessment of bone density to determine underlying bone health. Treatment usually includes rest, activity modification, and possibly physical therapy to strengthen surrounding muscles and improve bone health. In cases where osteoporosis is a contributing factor, management may also involve pharmacological interventions to enhance bone density.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between stress fractures and other types of fractures.
  • Need for accurate documentation of bone density status.
  • Potential for co-morbid conditions affecting bone health.
  • Variability in presentation and symptoms among patients.

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury.
  • Failure to document bone density status.
  • Misclassification of the type of fracture.
  • Lack of follow-up documentation on treatment and recovery.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes on the mechanism of injury, imaging results, and treatment plan.

Common Clinical Scenarios

Athletes presenting with upper arm pain, patients with a history of osteoporosis experiencing new pain.

Billing Considerations

Ensure that all imaging studies are documented and that the patient's activity level is noted.

Endocrinology

Documentation Requirements

Assessment of bone density through DEXA scans and documentation of any osteoporosis treatment.

Common Clinical Scenarios

Patients with osteoporosis presenting with stress fractures.

Billing Considerations

Document any medications affecting bone metabolism.

Coding Guidelines

Inclusion Criteria

Use M84.321 When
  • Follow official ICD
  • 10 coding guidelines for fractures, ensuring accurate documentation of the site and type of fracture
  • Include any relevant history of osteoporosis or other bone density disorders

Exclusion Criteria

Do NOT use M84.321 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97001CPT Code

Physical therapy evaluation

Clinical Scenario

Used for assessing rehabilitation needs post-fracture.

Documentation Requirements

Detailed evaluation notes and treatment plan.

Specialty Considerations

Orthopedic specialists should document the patient's functional status.

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. The granularity of ICD-10 codes helps in understanding the prevalence of stress fractures in various populations and aids in research and treatment planning.

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. The granularity of ICD-10 codes helps in understanding the prevalence of stress fractures in various populations and aids in research and treatment planning.

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. The granularity of ICD-10 codes helps in understanding the prevalence of stress fractures in various populations and aids in research and treatment planning.

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 caused by repetitive stress on the bone, while a regular fracture typically results from a single traumatic event. Stress fractures often develop gradually and may not be visible on initial X-rays.