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ICD-10 Guide
ICD-10 CodesM84.36

M84.36

Billable

Stress fracture, tibia and fibula

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

Code Description

ICD-10 M84.36 is a billable code used to indicate a diagnosis of stress fracture, tibia and fibula.

Key Diagnostic Point:

A stress fracture of the tibia and fibula 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 individuals with low bone density or osteoporosis, where the bones are more susceptible to fractures. The tibia, or shinbone, is the larger of the two bones in the lower leg, while the fibula is the thinner bone located alongside it. Stress fractures can result from various factors, including inadequate nutrition, hormonal imbalances, and biomechanical issues such as improper footwear or running techniques. Symptoms typically include localized pain that worsens with activity and improves with rest. Diagnosis is often confirmed through imaging studies, such as X-rays or MRI, which can reveal the fracture line and assess the surrounding bone density. Treatment generally involves rest, modification of activities, and in some cases, physical therapy to strengthen the surrounding muscles and improve bone health. Monitoring bone density is crucial, especially in patients with osteoporosis, to prevent future fractures.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between acute and chronic stress fractures
  • Understanding the impact of underlying bone density disorders
  • Identifying the specific location of the fracture within the tibia and fibula
  • Documenting the patient's activity level and risk factors accurately

Audit Risk Factors

  • Inadequate documentation of the patient's bone density status
  • Failure to specify the location of the stress fracture
  • Lack of evidence for conservative treatment measures taken
  • Misclassification of the fracture type (stress vs. acute)

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, patient history, and treatment plans must be documented.

Common Clinical Scenarios

Athletes presenting with leg pain, patients with osteoporosis experiencing new pain.

Billing Considerations

Ensure that all relevant imaging studies are included in the documentation to support the diagnosis.

Endocrinology

Documentation Requirements

Bone density test results and hormonal assessments should be included.

Common Clinical Scenarios

Patients with osteoporosis presenting with stress fractures.

Billing Considerations

Document any underlying metabolic bone disorders that may contribute to fracture risk.

Coding Guidelines

Inclusion Criteria

Use M84.36 When
  • According to ICD
  • 10 guidelines, M84
  • 36 should be used when a stress fracture is confirmed through imaging
  • It is important to document the patient's bone density status and any contributing factors such as osteoporosis

Exclusion Criteria

Do NOT use M84.36 When
  • Exclusion criteria include acute fractures and other types of bone injuries

Related ICD-10 Codes

Related CPT Codes

73630CPT Code

Radiologic examination, tibia and fibula

Clinical Scenario

Used when imaging is required to confirm a stress fracture.

Documentation Requirements

Include imaging reports and clinical notes detailing the patient's symptoms.

Specialty Considerations

Orthopedic specialists should ensure imaging is appropriate for the suspected diagnosis.

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. It has also emphasized the importance of documenting underlying conditions such as osteoporosis.

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. It has also emphasized the importance of documenting underlying conditions such as osteoporosis.

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 injuries. It has also emphasized the importance of documenting underlying conditions such as osteoporosis.

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 is typically the result of a single traumatic event. Stress fractures often develop gradually and may not be visible on initial X-rays.