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v1.0.0
ICD-10 Guide
ICD-10 CodesM84.362

M84.362

Billable

Stress fracture, left tibia

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

Code Description

ICD-10 M84.362 is a billable code used to indicate a diagnosis of stress fracture, left tibia.

Key Diagnostic Point:

A stress fracture of the left tibia 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 those with underlying bone density disorders such as osteoporosis, where the bone's structural integrity is compromised. Stress fractures typically develop gradually, presenting with 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 or associated bone edema. Treatment generally involves rest, modification of activities, and in some cases, the use of supportive devices like braces. In patients with osteoporosis, addressing the underlying bone density issues is crucial to prevent future fractures. This condition highlights the importance of bone metabolism and the need for adequate calcium and vitamin D intake to maintain bone health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between acute and stress fractures
  • Understanding the impact of underlying bone density disorders
  • Variability in presentation and symptoms among patients
  • Need for precise documentation of activity levels and risk factors

Audit Risk Factors

  • Inadequate documentation of the patient's activity level
  • Failure to note underlying osteoporosis or other bone density disorders
  • Misclassification of stress fractures as acute fractures
  • Lack of imaging documentation to support the diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Athletes presenting with leg pain after increased training intensity.

Billing Considerations

Ensure documentation reflects the chronic nature of stress fractures and any underlying bone health issues.

Endocrinology

Documentation Requirements

Assessment of bone density, history of osteoporosis, and treatment for metabolic bone disease.

Common Clinical Scenarios

Patients with osteoporosis experiencing stress fractures due to minimal trauma.

Billing Considerations

Documenting the patient's bone health status and any medications affecting bone density.

Coding Guidelines

Inclusion Criteria

Use M84.362 When
  • According to ICD
  • 10 guidelines, M84
  • 362 should be used when a stress fracture is confirmed through imaging
  • It is important to document the location, type of fracture, and any underlying conditions such as osteoporosis

Exclusion Criteria

Do NOT use M84.362 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

73630CPT Code

Radiologic examination, tibia and fibula

Clinical Scenario

Used when imaging is performed to confirm a stress fracture.

Documentation Requirements

Include the reason for the imaging and findings.

Specialty Considerations

Orthopedic specialists should document the clinical rationale for imaging.

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. M84.362 provides a clear distinction between types of fractures, which aids in better patient management and treatment planning.

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. M84.362 provides a clear distinction between types of fractures, which aids in better patient management and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. M84.362 provides a clear distinction between types of fractures, which aids in better patient management 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 an acute fracture?

A stress fracture is a small crack in the bone caused by repetitive stress, while an acute fracture is a complete break in the bone due to trauma. Stress fractures develop gradually and often require different management strategies.