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ICD-10 Guide
ICD-10 CodesM84.359

M84.359

Billable

Stress fracture, hip, unspecified

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

Code Description

ICD-10 M84.359 is a billable code used to indicate a diagnosis of stress fracture, hip, unspecified.

Key Diagnostic Point:

A stress fracture of the hip is a small crack in the bone that occurs due to repetitive force or overuse, often seen in athletes or individuals with increased physical activity. This condition is particularly prevalent in patients with underlying bone density disorders such as osteoporosis, where the bones are more fragile and susceptible to fractures. Stress fractures may not always present with acute symptoms, making them challenging to diagnose. Patients may report localized pain that worsens with activity and improves with rest. The hip region is a critical area for mobility, and stress fractures can significantly impact a patient's quality of life. Diagnosis typically involves imaging studies, such as X-rays or MRI, to confirm the presence of a fracture. Treatment often includes rest, modification of activities, and in some cases, physical therapy to strengthen surrounding muscles and improve bone health. Understanding the underlying causes, such as bone metabolism disorders, is essential for effective management 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 for accurate diagnosis
  • Differentiation from other types of fractures
  • Potential for co-existing conditions like osteoporosis

Audit Risk Factors

  • Inadequate documentation of the patient's activity level
  • Failure to document underlying bone density disorders
  • Misclassification of the fracture type
  • Lack of imaging results in the medical record

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Athletes presenting with hip pain after increased training, elderly patients with hip pain and history of osteoporosis.

Billing Considerations

Ensure clear documentation of the patient's bone health status and any previous fractures.

Endocrinology

Documentation Requirements

Assessment of bone density, history of osteoporosis, and management of metabolic bone diseases.

Common Clinical Scenarios

Patients with osteoporosis presenting with stress fractures, evaluation of bone metabolism disorders.

Billing Considerations

Document any treatments for osteoporosis and their impact on fracture risk.

Coding Guidelines

Inclusion Criteria

Use M84.359 When
  • Follow ICD
  • CM guidelines for coding fractures, ensuring specificity in documentation
  • Include details about the location, type, and cause of the fracture

Exclusion Criteria

Do NOT use M84.359 When
  • Exclude codes for acute fractures or those with specific anatomical locations

Related ICD-10 Codes

Related CPT Codes

73630CPT Code

Radiologic examination, hip, unilateral

Clinical Scenario

Used when imaging is performed to assess for stress fractures.

Documentation Requirements

Document the reason for 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. M84.359 provides a clear designation for unspecified stress fractures, aiding in data collection and analysis.

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. M84.359 provides a clear designation for unspecified stress fractures, aiding in data collection and analysis.

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. M84.359 provides a clear designation for unspecified stress fractures, aiding in data collection and analysis.

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 hip?

Common causes include repetitive weight-bearing activities, sudden increases in physical activity, and underlying conditions such as osteoporosis that weaken bone structure.

How can stress fractures be prevented?

Prevention strategies include gradual increases in activity levels, proper footwear, strength training, and ensuring adequate calcium and vitamin D intake to support bone health.