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ICD-10 Guide
ICD-10 CodesM84.364

M84.364

Billable

Stress fracture, left fibula

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

Code Description

ICD-10 M84.364 is a billable code used to indicate a diagnosis of stress fracture, left fibula.

Key Diagnostic Point:

A stress fracture of the left 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 those with underlying bone density disorders such as osteoporosis, where the bone's structural integrity is compromised. The fibula, a long bone located on the lateral side of the lower leg, can sustain stress fractures due to its role in weight-bearing and stability during movement. Symptoms typically include localized pain, swelling, and tenderness along the fibula, which may worsen with activity and improve with rest. Diagnosis is often confirmed through imaging studies such as X-rays or MRI, which can reveal the fracture and assess the surrounding bone density. Management may involve rest, immobilization, and physical therapy, with a focus on addressing any underlying bone metabolism issues to prevent future fractures. Understanding the relationship between stress fractures and bone density is crucial for effective treatment and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between stress fractures and other types of fractures.
  • Understanding the patient's history of bone density disorders.
  • Documenting the specific location and nature of the fracture.
  • Identifying associated conditions that may affect treatment.

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury.
  • Failure to note previous fractures or bone density issues.
  • Misclassification of the fracture type.
  • Lack of follow-up documentation regarding treatment and recovery.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, treatment plans, and follow-up notes.

Common Clinical Scenarios

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

Billing Considerations

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

Endocrinology

Documentation Requirements

Bone density test results, history of metabolic bone disease.

Common Clinical Scenarios

Patients with osteoporosis presenting with fractures, individuals on long-term corticosteroid therapy.

Billing Considerations

Document any treatments for osteoporosis or metabolic bone disorders.

Coding Guidelines

Inclusion Criteria

Use M84.364 When
  • According to ICD
  • 10 guidelines, M84
  • 364 should be used when a stress fracture is confirmed through imaging
  • It is essential to document the specific location and any relevant history of bone density disorders

Exclusion Criteria

Do NOT use M84.364 When
  • Exclusion criteria include acute fractures or fractures due to trauma

Related ICD-10 Codes

Related CPT Codes

73630CPT Code

Radiologic examination, lower leg

Clinical Scenario

Used when imaging is performed to confirm a stress fracture.

Documentation Requirements

Include imaging results and interpretations.

Specialty Considerations

Orthopedic specialists should ensure imaging is relevant to the 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 accuracy of data collection and reimbursement processes. M84.364 provides a clear distinction from other fracture types, enhancing clinical understanding 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. M84.364 provides a clear distinction from other fracture types, enhancing clinical understanding and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. M84.364 provides a clear distinction from other fracture types, enhancing clinical understanding 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 a small crack in the bone caused by repetitive force or overuse, while a regular fracture typically results from a single traumatic event. Stress fractures often occur in bones weakened by conditions like osteoporosis.